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THE DOCTOR IN WAR. Illustrated. 
CIVILIZATION AND HEALTH. 
COMMON DISEASES. 
A HAND-BOOK OF HEALTH. Illustrated. 
THE CONQUEST OF CONSUMPTION. Illus- 
trated. 
PREVENTABLE DISEASES. 

HOUGHTON MIFFLIN COMPANY 

Boston and New York 



THE DOCTOR IN WAR 




WAITING FOR THE HOSPITAL TRAIN TO START 



THE DOCTOR 

IN WAR 

By 

Woods Hutchinson, M.D. 

WITH ILLUSTRATIONS 




BOSTON AND NEW YORK 

HOUGHTON MIFFLIN COMPANY 

fltfce Ifttoergi&e pre$£ Cambridge 

1918 






COPYRIGHT, 1918, BY WOODS HUTCHINSON 
ALL RIGHTS RESERVED 

Published November iqi8 



2.FO 



DEC -4 (918 



©CLA508398 



PREFACE 

Believing that the doctor and the sanitarian would play an 
important and by no means discreditable part in this World 
War, after offering my services to friends on the British 
Army Medical Staff, only to find that they could not accept 
any one, save on the terms of taking the oath of allegiance and 
losing American citizenship, I decided to attempt to visit and 
study the medical arrangements on the Western Fronts. 

As I had more than half anticipated, I found there the 
finest and most triumphant demonstration of what modern 
science can do for the protection of the health and life of 
an army or a nation ever given in history, equaling if not 
surpassing the hitherto unrivaled victory of the forces which 
save life on the Panama Canal. 

Thanks to the personal kindness of the Secretary of War y 
Mr. Baker, and of my friend Colonel Roosevelt, together 
with the courtesy of my medical colleagues, I secured letters 
of introduction and papers which made me successful beyond 
my expectations in securing permission to see almost every- 
thing of any value or interest from a medical and public 
health point of view, from the Base Hospitals up to the Aid 
Posts in the front-line trenches and from the munition 
works and Training-Camps to the Hospital Ships and the 
British Fleet. 

I was gone practically a year, from January 15 to De- 
cember 24, 1 qi 7, and spent about three months in England, 
going and returning, visiting the Base Hospitals, the Train- 
ing-Camps, the munition factories, and the re-fitting estab- 
lishments for the blind and the crippled, winding up with a 



vi PREFACE 

week's visit to the British Fleet and its Hospital Ships, 
Ambulance Trains, and Naval Hospitals. 

Then I was granted a special permit to visit the medical 
arrangements of the British Army in France and spent 
nearly three weeks on the Front tracing the course of the 
wounded from the front-line trenches through the Dressing- 
Stations, the Casualty Clearing-Stations, or Field Hospi- 
tals, back to the great Base Hospitals, including the huge 
group Hospital-Camp of 35,000 beds at Etaples, where the 
Harvard Units are. 

The English authorities passed me through to Paris, 
where I spent nearly six months making frequent trips out 
to the Hospitals and trenches of the French Front, to Sois- 
sons, to 'Carrel's Hospital at Compilgne, Chateau-Thierry, 
the "pays reconquis" the Chemin des Dames, Rheims 
(twice), the Argonhe, Saint- Menehould, Verdun, Alsace; in 
the intervals visiting the great Paris hospitals, and schools 
for re-education of the crippled, munition works, sanatoria 
for tuberculosis, homes for the refugees, and finally spend- 
ing four days with the Red Cross among the " rapatries " 
at Evian. 

Early in August I went to the Italian Front, visiting eight 
or ten of the big War Hospitals in Rome en route, and had a 
fascinating four weeks on the Isonzo, while the big Italian 
offensive was under way, which opened so hopefully and 
ended only a couple of weeks after I left in such a distressing 
temporary backset. Some of the best hospitals and service 
for the care of the wounded that I saw anywhere were in Italy, 
and I formed a very high opinion of the Italian Army and its 
organization and fighting morale. 

Back to Paris in September, where I tried to enlist in our 
Army Medical Reserve Corps, but found I was too old! — 



PREFACE vii 

to my huge disgust; out to our American Zone in France 
along the foothills of the Vosges, for ten days with our boys 
in their billets; thence back through the British lines, to visit 
all our American Hospital Units which were serving in 
English Hospitals, nine in all, through to London to deliver 
the Chadwick Lectures on War Hygiene at the Royal Society 
of Medicine, and complete my visits to the War Hospitals 
and munition works; and so on home. 

It is the first war where the doctor has been given a free 
hand, and he has responded by almost wiping out disease, 
making the death-rate from it in the camps lower than that 
at home, saving ninety per cent of the wounded and sending 
eighty per cent of them back to the firing-line within forty 
days! and making the death-rate from all causes in this 
most horrid-sounding and appalling of wars the lowest 
on record, barely three per cent per annum, and for the past 
two years under two per cent. 

Asa consequence he has become such a valuable part of the 
fighting force that he has lost all his former immunities. He 
and his insignia, the Red Cross, as well as his stretcher- 
bearers and his wounded, are eagerly fired upon by the Huns, 
who count one doctor worth five hundred soldiers and one 
stretcher-bearer the equivalent of ten combatants and issue 
orders to their snipers and machine-gunners accordingly. 

He lives under fire, sleeps underground, operates in a 
gas-mask, and if captured is sent to a prison-camp like a 
line officer, in flat defiance of all the rules of civilized warfare. 
He is even contemplating bearing arms to defend himself and 
his wounded. Blessings (?) on the Hun! I ! 

The courtesies shown me on every hand wherever I went 
were so constant, so gracious, and so innumerable that it 
seems almost invidious to mention individual names. If there 



viii PREFACE 

are to be found anywhere a body of more kindly, courteous, 
and considerate men than both the Medical and Line Army 
officers of the English, French, and Italian commands, it 
would be difficult for me to imagine them. I must have been 
an awful nuisance to them sometimes with my requests for 
visits and information in the hurry and strain of open war, 
but they never allowed me to see it, and my opinion of war as 
a school of manners is of the very highest. 

But I do feel under special and peculiar obligations, for in- 
valuable and most helpful courteous permissions and assist- 
ance, to Sir Alfred Keogh, Director-General of the Royal 
Army Medical Corps, and to Colonel Horrocks and Major 
Smales of his staff in England; to General W. G. MacPher- 
son, of the Medical G.H.Q. in France, and Sir George 
Makins, Consulting Surgeon to the British Armies in 
France; to Lord Northcliffe and Sir George Riddell, for the 
splendid opportunities afforded me of visiting the medical 
arrangements of the British Army both in the Training- 
Camps and in France; also to Mr. Sidney Walton, of the 
Ministry of Munitions, and to Colonel John Buchan and 
Mr. St. John Hutchinson, of the Foreign Office, for most 
courteous and valued assistance and permission to visit the 
British Fleet and the great English munition works. 

My warmest acknowledgments are also due to our Am- 
bassador in Paris, Mr. William G. Sharp, not only for most 
helpful official assistance, but for unfailing and constant per- 
sonal kindness; to M. Justin Godard, Sous-Secretaire of 
War for Sanitary and Medical Affairs, and to Surgeon-Gen- 
eral Tuffier, of the French A rmy Medical Corps, for permis- 
sion and most kindly assistance and facilities in visiting the 
various Sectors of the French Front. 

For my Italian visit and the most liberal facilities af- 



PREFACE 



IX 



forded me on the Isonzo and Trentino Fronts, I owe my most 
cordial and grateful thanks to the Italian Ambassador in 
Paris ; Marchese Selva di Reggio, and to the Comando 
Supremo at Udine. 

Many of the chapters of the book have previously ap- 
peared in magazine and syndicate articles, and I wish to 
acknowledge my indebtedness to the Editors of the " Satur- 
day Evening Post" the " Metropolitan Magazine" the Star 
Publishing Company, "Harper's Magazine," "Pearson's 
Magazine" (London), and the "Daily Mail" (London). 



CONTENTS 



I. The Triumph of the Doctor . 
II. The Real Perils of War . 

III. Feeding a Million Men . 

IV. The Superb Health of the Armies 
V. The Land of the Happy Warrior 

the Cheerful Wounded 
VI. A Day in a French Field Hospital 
VII. The Risks of a Red Cross Nurse. 
VIII. Gas-Gangrene and Tetanus . 
IX. Healing the Wounds of War, or 
Carrel Triumph .... 

X. The Stranglers 

XI. The Drinking- Water of the Soldier 
XII. Guarding the Health of our 
American Troops in France 

XIII. New Faces for Old and Making a 

TION EQUAL A WHOLE 

XIV. The New Diseases of the War 
XV. Keeping the Camps Healthy 

XVI. The Problem of Tuberculosis 
XVII. The Plagues of Armies . 



i 

21 
51 

83 



AND 



• 95 

• 113 

• 125 
. 132 

THE 

• 147 
. 168 

• 197 



First 



Frac- 



209 

227 
248 
262 
275 
293 



xii CONTENTS 

XVIII. The Effects of War on the Civil Popu- 
lation 313 

XIX. Guarding the Health of the Navy . 331 

XX. Shell-Shock and the Mental Strain 

of War 358 

XXI. The Health of the Aviator: Saving 

the Bird-Man from Extinction . . 380 

XXII. The University of the Army: War as 

a College Course 403 

XXIII. The Armies at Play 415 

XXIV. The Pulse and Temperature of France 430 
XXV. Mountains and Medicine: Italy's War 

on Disease : 444 



ILLUSTRATIONS ' 

Waiting for the Hospital Train to Start 

Frontispiece 
Inoculation at Salonica . 12 - 

A Wounded French Soldier returning on Foot 
to the Dressing-Station 38 * 

Photographic Section of the French Army 

A Group of Lady Ambulance-Drivers ... 44 

Quinine Parade in the Salonica Army . . . 48 v 

A wounded Man cheered by a Chaplain as he is 
brought in on the llght railway, western 
Front 96 

Wounded on the Light Railway, Salonica Front 96 
Dressing a Guards Officer on a Flanders 
Battle-Field 100 

Canadian Red Cross Men attending to Wounded 
Germans at an Advance Dressing-Station . 100 

Canadian Official Photograph 

*n a French Underground Dressing-Station . 104 

French War Office Official Photograph 

Lady Lorry-Drivers 120 

A Cheerful Wounded Canadian Officer board- 
ing a Hospital Train 120 

Photograph from the Canadian War Records Office 



xiv ILLUSTRATIONS 

A VA.D. at Work in France 126 

Sleds used for Conveying the Wounded 
through the mud on the french front . . 142 

Arrival of Wounded at a French Base Hospital 158 

French Wax Office Official Photograph 

Transporting Wounded to a Field Dressing- 
Station on the Salonica Front . . . .174 

Bringing in a Wounded Canadian through the 
Mud on the Western Front 174 

Photograph from the Canadian War Records Office 

A Patient coming on board a Hospital Barge . 206 

A Fracture Case in a Hospital on the Western 
Front 238 

A Stretcher-Bearer Party coming through the 
Mud 266 

A British Tommy helping a German Prisoner 
carry a Wounded German through the 
Trenches 266 

Ambulance and Dispatch-Rider coming from a 
Battle on the Salonica Front .... 298 

Canadian Wounded going to the Dressing-Sta- 
tion on a Light Railway 314 

Canadian Official Photograph 

Stretcher-Drill: Taking an "Injured" Man 
below for Treatment 346 

An Advance Dressing-Station near the Line on 
the Western Front 3S0 



ILLUSTRATIONS xv 

Indian Soldiers carrying in one of their Offi- 
cers * 412 V 

Serbian Wounded coming from the Mountains . 446 1/ 
Transportation of Wounded by Trolley in the 

Italian Mountains 468 ^ 

From an Italian Photograph 

Italian War Dogs 480 

Italian Official Photograph 

Except as otherwise stated the Illustrations are from 
British Official Photographs 



THE DOCTOR 
IN WAR 

i 

THE TRIUMPH OF THE DOCTOR 

Saving Science versus Destructive Science 

WAR, like life, is full of contradictions. Aim- 
ing solely at the destruction of enemy life by 
its own legitimate and special weapons, it actually 
destroys and loses five times as many soldiers by 
disease as in battle, and while waged solely between 
armed men, its heaviest slaughter has always been 
among women and children. When a soldier bravely 
enlists for the defense of his country, he thinks only 
of facing the risks of battle and sudden death, but 
until this war his far greatest risk was that of dying of 
typhoid or cholera in a summer camp, or pneumonia 
in a winter one. 

The doctor has made this world-struggle probably 
one of the least deadly ever fought in proportion to 
the numbers engaged. Less than one twentieth of 
the wastage of ancient war — that is, three years or 
more ago — was due to wounds or deaths in battle, 



2 THE DOCTOR IN WAR 

the other ninety-fiye per cent was caused by disease, 
epidemics, and pestilences, both in the field and at 
home. In the armies themselves the ratio was six 
to nine deaths by disease to one in battle or from 
wounds. In this war the ratio has been double re- 
versed — sixteen deaths in battle to one from dis- 
ease. 

By wiping out epidemics the doctor has actually 
kept the death-rate among the civil populations of 
the Allied countries as low as, and in some cases 
lower than, it was before the war. By redoubling the 
care and protection of young children almost as many 
additional young lives have been saved, as adult 
ones have been on the field of battle. So that the 
populations of the Allied countries are practically 
holding their own. 
\ The doctors control over wound infections is so 
masterly that of the wounded who survive six hours 
ninety per cent recover, of those who reach the field 
hospitals ninety-five per cent recover, and of those 
who arrive at the base hospitals ninety-eight per cent 
get well. The twin angels, anaesthetics and antisep- 
tics, have not only enormously diminished pain and 
agony, but have made amputations rarer and grave 
cripplings fewer than ever before in war history. 
Barely two per cent of the wounded are crippled or 
permanently disabled. 

From the statistics made public there is good rea- 



THE TRIUMPH OF THE DOCTOR 3 

son to believe that the death-rate of this war, in 
spite of the colossal increase in instruments and en- 
gines of scientific slaughter, does not much exceed 
three per cent per annum. The same ingenuity that - 
sharpened the attack has strengthened the defense. 
The spade is mightier than the shrapnel, the scalpel 
than the sword, the test tube than the trench mor- 
tar. Chlorine saves more lives, as Dakin's fluid in 
wounds and bleaching powder in drinking-water, 
than it destroys as poison gas. 

An army camp used to be a hotbed of epidemics, 
a breeding-place of pestilences. The soldier's worst 
enemy enlists with him, for what killed most men 
in war was not bullets, but ' ' bugs," not the sword but - 
the streptococcus. Whenever you mobilize and call 
to the colors a thousand men, you call with them at 
least twenty billion tubercle bacilli, ten billion ty- 
phoid, five billion pneumonia, and a couple of mil- 
lion dysentery germs. An army assembles literally 
primed and loaded for trouble — fromjbhe inside. 

The first thing an army in the field does is to foul 
its own water-supply and the second is to infect its 
food by the swarms of flies bred in its garbage dumps 
and manure heaps. 

In the old days armies simply rotted with disease 
in their winter quarters ; forces which had gone into 
winter canip nrgood health and spirits were often 
so reduced in the spring as to be actually unable to 



4 THE DOCTOR IN WAR 

take the field. Gustavus Adolphus once broke camp 
and started on his spring campaign two months ear- 
lier than he had intended simply for fear he would 
not have any army left to campaign with if he 
waited till summer. 

The armies in Flanders and northern France last 
winter, out in open trenches in some of the vilest and 
" sickliest " weather troops ever had to face, had less 
sickness and fewer deaths from pneumonia and all 
other diseases than they used to have in barracks in 
time of peace and far less than the general civil popu- 
lation at home. 

Inoculation protected them against typhoid ; splen- 
did feeding, withj3lejrty_jc^^ and fat, against 
pneumonia and consumption; fly campaigns against 
dysentery and diarrhoea; shower baths and clean 
underwear against spotted typhus; and quarantine 
against all the mild, infectious measles, summer 
diarrhoea, diphtheria, and influenza. 

The old plagues of army camps, cholera, Black 
Death, and spotted typhus, all lifted their heads and 
began to "resurrect," in Italy, in Serbia, and in Rus- 
sia, but all were promptly stamped out by modern 
sanitary science — cholera by isolation, disinfec- 
tion, and the vaccine, Black Death by exterminating 
fleas, typhus by "unlousing" and hot shower baths. 
" There is no armor against Fate," but when it 
comes to typhus a clean undershirt pretty well fills 



THE TRIUMPH OF THE DOCTOR 5 

the bill and is a better life protector than any shirt 
of mail. 

Only three new inventions in the disease line have 
appeared in this war: trench fever, trench nephritis, 
and trench feet. The last two are still a puzzle as to 
causation, but all three have been brought down to 
comparatively slight proportions and importance, by 
good sanitation, properly drained trenches, loose, 
comfortable foot- and leg-wear, regular washing and 
greasing of the feet every night, clean socks and 
plenty of them. Trench fever has been proved to be 
carried by the bite of the louse or " cootie.* ' 

The mental damage inflicted upon the soldier "by 
the horrors and strains of this war has been aston- 
ishingly small. The total number of cases of serious 
or lasting "shell shock," so called, and mental dis- 
turbance in the British Army in France during 1916 
was twenty-six hundred, less than one per thousand 
of the armies in the field and little more than the ordi- 
nary insanity rate in men of military ages in times 
of peace. 

Modern nerves have stood the fearful strain of this 
war superbly, and the more "modern" and citified 
they are the better they stand it. Men of every race, 
color, and grade of civilization have been tested in 
this war, and while all were brave and devoted and 
with the highest respect for the noble and loyal serv- 
ice rendered by tropical and Oriental troops, none 



6 THE DOCTOR IN WAR 

have borne the ghastly horrors of shell and mine 
and poison gas so well as the highly civilized white 
races. And without invidious distinction, among 
the steadiest, stanchest, and most "shell-proof" of 
all stands the highly citified and alleged "neurotic" 
Cockney. 

As for the ancient and classic plague of armies, 
venereal disease, in spite of the special temptations 
to which soldiers in the field are exposed, away from 
home associations and ties, — any pleasure may be 
their last, etc., — and in spite of the disgraceful 
solicitations to which a silly sentimentalism and os- 
trich-like Puritanism permit them to be subjected 
in London on leave, here are the figures: — 

Venereal 
disease 

British Army in time of peace (1905) 12 per 100 

" " " " " " (1913) 6 

" at home (1916) 3 

" " in France (1916) 2.4 

In other words, the average incidence of venereal dis- 
ease in the British Army in France is no higher than 
that believed to exist among men of military age 
in time of peace; while in the American army in 
France, by cutting out sentiment and treating vene- 
real disease like any other contagious disease, it has 
been brought down to less than one per cent. 

If we would stop preaching and exhorting about 
venereal disease as a moral problem and treat it 
strictly as a sanitary one, for the duration of the war, 



n <« 

<« (i 



THE TRIUMPH OF THE DOCTOR 7 

we could soon bring it well below its former preva- 
lence in times of peace. Especially if, in addition, we 
would frankly recognize the prostitute for what she 
really is — a helpless feeble- wit, selling her body be- 
cause she has no brains to sell — and take charge of 
her as a permanent ward of the State in beautiful, 
comfortable cottage colonies out in the open country. 

If the soldier on leave were systematically pro- 
vided with easy, abundant opportunities to meet and 
dance and go sight-seeing with nice girls and women 
he would never miss the bad ones, for the minds of 
young men are cleaner than those of most of the 
middle-aged who exhort them. 

At first sight it would appear as if the doctor could 
do little to limit the deadliness and slaughter of war. 
He could bind up wounds and ease pain and nurse 
the sick, but what could he do to stop bullets from 
finding their billet or shells from bursting in crowded 
trenches? But this idea, plausible as it sounds, is 
due solely to the fact that, until recent years, no 
one realized, or even knew, what an enormously 
large part disease has played in the death-rate of an 
army. 

Just as an illustration of the real deadliness and 
true perils of former wars may be cited the famous 
Thirty Years' War. It is estimated that during this 
fierce and bloody strife, which ranged from the Medi- 
terranean to the Baltic for a full generation, the pop- 



8 THE DOCTOR IN WAR 

ulation of Central Europe was reduced from nearly 
thirty million to less than thirteen million. Yet in 
the whole of this time only about fifty important 
battles were fought, whose total losses in killed and 
wounded amounted to less than half a million men. 

All the other fifteen million died of disease and 
famine and pestilence. The population of one city, 
for instance, Oldenburg, shrank from nearly four hun- 
dred thousand to less than seventy thousand, and it 
had never been besieged nor had any battles been 
fought in its near neighborhood. 

When Napoleon, having conquered Europe, turned 
his ambition and attention to America, it was pes- 
tilence and not powder and ball which barred his way 
and sent him down to utter defeat. He landed an 
army of fifteen thousand men, splendidly equipped, 
on San Domingo; they were to seize the island, 
build camps, and prepare a base from which the 
real army, which was to follow them, could conduct 
operations against Mexico and New Orleans. But 
the fierce guardian angels of the tropics, yellow fever 
and malaria, fell upon them, and before the main 
army could start, there were barely three thousand 
of them left alive, and the project was abandoned 
in dismay. Six months later a couple of French ships 
from Martinique came and carried off the few hun- 
dred wretched survivors. 

On the other side of the Napoleonic struggle, 



THE TRIUMPH OF THE DOCTOR 9 

Wellington's army in the Peninsula lost ten times as 
many men from disease as from battle, and more in 
one winter's encampment without any fighting than 
injthe whole previous summer's campaign, and this 
represents about the general ratio between diseases 
and battle casualties during the last century. 

Contrary to immortal popular tradition, which is 
usually wrong, Napoleon's ghastly defeat in his final 
Russian campaign was due neither to the wasting of 
the country with fire and sword by the Russians as 
they retreated — for the Great Commander never for 
a moment attempted to live off the country in any of 
his campaigns, and insisted upon his armies being 
as well supplied with food as they were with ammu- 
nition — nor yet by "General January and General 
February." For in spite of all the snow-scene pic- 
tures which have been painted of the great retreat, 
remnants of his army came back across the Beresina 
early in November, before the winter had set in. The 
real enemy that mowed down his magnificent army, 
well-fed, well-clothed, superbly equipped as it was, 
was spotted typhus, duejtojice, which raged through 
its ranks like a forest fire. 

By the middle of the last century the death-rate 
from disease in war had fallen somewhat, and in the 
American Civil War the ratio was about five deaths 
from disease to one in battle. Almost the same ratio 
was maintained in the Spanish-American War and 



io THE DOCTOR IN WAR 

the Boer War in spite of sanitary improvements, 
and the first clean reduction was made in the Russo- 
Japanese War on the Japanese side. It was here for 
the first time in history that the doctor was given real 
power and authority in an army and the control of 
its sanitary conditions. This brilliant new nation was 
just innocent enough actually to put into practice 
the sanitary principles which all the European armies 
had simply talked about, but never dreamed of put- 
ting into force, with . the result that the death-rate 
from disease fell to less than half its former amount 
— that is, to about two and one half times as great 
as the battle- and wound-rate. 

This was the record performance when the present 
war broke out, but we have beaten it " out of sight," 
as the Westerners say, already. The example of 
Japan has not been wasted ; the army doctor has been 
taken seriously from the start, and the sanitarian 
has been given a chance to make good his claims 
of prevention, with the cheering and almost incredi- 
ble result that the ratio of deaths from disease to 
those from bullets has been something like double 
reversed, from five to one, to more than ten to one 
in the opposite direction. That is to say, that in- 
stead of five men dying of disease to every one in" 
battle, in the British army on the Western front, 
only one life has been lost by disease to every ten 
in battle. In fact, disease as a factor in the army 



THE TRIUMPH OF THE DOCTOR n 

J death-rate has been almost wiped out, completely so in 
the sense that the amount of sickness in the camp and 
the deaths from disease at the front have been barely 
half what they were in barracks in times of peace. 

This magnificent result, which amounts to the 
saving of at least four hundred thousand lives a 
year on the British Western front alone, has been 
brought about chiefly in three ways, protection of the 
troops against infectious disease by the anti-typhoid 
inoculations and other sanitary measures, by surgi- 
cal skill and superb hospital organization enormously 
increasing the recovery rate from wounds, and by 
the splendid way in, which the armies have been fed. 

The greatest single sanitary triumph of the war 
has been the wiping out of typhoid fever by means 
of inoculation or vaccination. This is the real plague 
of armies in the temperate zone, as may be illustrated 
by the fact that it caused twice as many deaths in 
our American Civil War as battle wounds did, five 
times as many in the Spanish-American War, and 
nearly twice as many in the Boer War. According 
to its former prevalence we should have had three 
hundred thousand cases a year on the British West- 
ern front alone, while as a matter of fact we have 
had only two thousand cases all told during three 
» years among nearly three million men. 

That this astounding, almost incredible reduction 
has been due to inoculation has been proved, first, 



12 THE DOCTOR IN WAR 

by the experience of our American army, which has 
scarcely had a death from typhoid in the six years 
since anti-typhoid vaccination was made compul- 
sory and complete; second, by the fact that both 
the French, and, I am happy to say, the German 
armies suffered heavily from typhoid during the first 
year of the war, less than ten per cent of them being 
protected by vaccination — as soon as they set about 
full and complete vaccination of their forces, within 
six months typhoid was almost at its vanishing 
point, without any further improvement of the sani- 
tary conditions of either army; third, by the fact 
that the typhoid rate among the small uninoculated 
minority of the English troops is ten times as great 
as that among the millions of inoculated, and the 
death-rate nearly forty times as great. 

After typhoid the two next deadliest and most 
serious camp diseases, diarrhoea and dysentery, 
have been kept under by scrupulous watchfulness 
over the water-supply, which in many areas has been 
brought in pipes, from streams or reservoirs many 
miles distant, or filtered in sand-beds, or, where this 
was impossible, disinfected by treating with chlorine, 
in the form of bleaching-powder. This last, if not 
very carefully done, sometimes leaves a disagreeable 
chemical taste in the water, at which the soldiers 
grumble a good deal, especially as it spoils the taste 
of their tea, a most vital and sensitive point. 




INOCULATION AT SALONICA 



THE TRIUMPH OF THE DOCTOR 13 

But in spite of occasional unpleasantness, the 
bleaching-powder in the water is a wonderful pro- 
tection and safeguard, as in quite moderate amounts 
it will destroy all germs of infection that may have 
got into the water, — diarrhoea, dysentery, typhoid, 
and cholera, — while at the same time it is harm- 
less to the human stomach, and if given sufficient 
time to neutralize and settle it leaves no unpleas- 
ant taste behind it. 

But the chief weapon against diarrhoea and dys- 
entery is relentless warfare against that unsuffer- 
able little pest and carrier of pestilences, the fly. 
His "beat" is of the simplest: he visits the latrines 
and loads up with the germs of dysentery, diarrhoea, 
or typhoid, flies to the tents and mess kitchens and 
distributes them broadcast over the food, both on 
the table and in the larders and kitchens, if left un- 
screened. 

In this war no mercy has been shown him; he has 
been cut off from his supplies of infections by burn- 
ing in incinerators all human excreta and other camp 
wastes. He has been shut out of the dining-rooms 
and kitchens by screens or windows. He has been 
trapped in a thousand ingenious ways, from sticky 
springs and strips and papers to big box-traps. 

Last, and deadliest of all, he has been deprived of 
any possible place to lay eggs and breed by burning 
or carting out on to the land all manure heaps, gar- 
bage dumps, and dirt piles. 



14 THE DOCTOR IN WAR 

x So successful has this warfare been that many of 
our army camps by constant vigilance have become 
'almost "fly less towns" and some of the most com- 
plete triumphs of this sort have been won on the 
Italian front with its sub- tropical climate. 

The second great victory over the death-rate of 
the war has been the wonderful skill and care of our 
doctors and nurses in the treatment and handling of 
wounds. In spite of the fact that the wounds in this 
war, being eighty to ninety per cent from shell frag- 
ments, have been the ghastliest, the most horribly 
lacerated, and the most vilely infected ever known, 
so that we had to go back to the beginning and 
start over again, the team-work between surgeon, 
ambulance, and nurse has been so superb that of the 
wounded who live long enough to be carried down to 
the ambulance, ninety per cent recover, of those 
who survive to reach the Casualty Clearing Station, 
ninety- five per cent recover; and of those who reach 
the Base Hospital, ninety-eight per cent recover. 

There are hospitals in England which have han- 
dled six, eight, ten thousand successive cases with 
only about three or four deaths in the thousand. 
Never was such a recovery-rate known in the world 
before. In the olden days fifty per cent was con- 
sidered an excellent recovery-rate, while as recently 
;as the American Civil War, the death-rate among 
the wounded was at least twenty per cent, and 



^ 



X 



f- 



THE TRIUMPH OF THE DOCTOR 15 

often, when hospital gangrene broke out, rose to 
^ forty and even sixty per cent. When it is further 
stated that of all the wounded eighty per cent are 
able to return to the front within a little over forty 
days, it will be seen what a powerful and immensely 
important factor in keeping up the strength of the 
army the doctor is to-day. Even the haughtiest line 
officer must admit that he is entitled to some au- 
thority and a voice in the direction of army affairs. 

This wonderful result and triumph of surgery has 
been brought about in face of the greatest difficulties 
from the beginning. For twenty years past the wounds 
of modern war have been becoming less deadly, be- 
cause less infected. So tremendous is the pressure 
and friction upon the high- velocity bullet as it is 
driven through the barrel of the modern rifle, that 
it is practically sterilized by heat and enters the 
body of its victim germ-free. Furthermore, by its 
whirling motion and pointed tip it makes a very 
small wound with an almost "seared" track, which 
is followed by very little hemorrhage unless it has 
struck a large artery. 

I have seen bullet wounds on the Western front 
in this war which had gone completely through an 
arm or a leg without hitting the bone, and were 
practically healed, with only a round dry scab at 
each end to show for them, inside of eight or ten days. 

But, alas, bullet wounds have played an aston- 



16 THE DOCTOR IN WAR 

ishingly small part of the casualties of this war ; from 
the beginning eighty-five per cent of all the wounds 
were from shell fragments, and this has since risen 
to ninety and ninety-five per cent. And a shell 
wound is everything that a wound should not be — 
huge, ragged, irregular, like the jagged and saw- 
tooth-edged fragments which produce it, and worst 
of all horribly infected. This is due to the fact that 
most shells not only strike the ground, but bury 
themselves somewhat before they explode, and 
hence every sharp-edged fragment comes up simply 
loaded with dirt and swarming with all the germs 
and filth that may be in the soil. 

As the fighting in Belgium and northern France 
has been over the most intensively cultivated and 
richly fertilized soil in Europe, all the germs which 
exist in stable manure and fertilizers of all sorts 
have been hurled into the utmost depths and remot- 
est corners of every wound. Unfortunately two of 
the deadliest germs known to surgery, the tetanus 
bacillus and the bacillus of gas gangrene, have their 
normal habitat in the intestines of the horse; there- 
fore there was a terrific outbreak of both tetanus and 
gas gangrene in the very first months of the war. 

The tetanus or lockjaw was quickly brought down 
by the use of the tetanus anti- toxin, and the gas 
gangrene was successfully attacked by new methods 
of operations and irrigating the wounds; but both 



THE TRIUMPH OF THE DOCTOR 17 

dangers still hang over us and can be avoided only 
by sleepless vigilance. 

Another service of great value to the war strength 
of the nation has been rendered by the doctor and 
the sanitarian which, although less dramatic and at- 
tracting less attention than that accomplished upon 
the field of battle, is almost equal to it in impor- 
tance. This is the persistent, tireless, successful war 
waged by our medical officers of health, our medical 
inspectors of factories and industries, and the vari- 
ous organizations for fighting tuberculosis and low- 
erinjfthe child death-rate. We have become, per- 
haps, accustomed to look upon this sort of vigilance 
as a matter of course and even inclined to be a little 
skeptical as to the reality of the dangers which we 
have avoided through its exercise. 

But the strain and stress of war have both in- 
creased its powers and brought its results into high 
relief, in the gratifying and encouraging fact that in 
spite of the absence of wage-earners, in spite of the 
anxiety and grief and hardship inseparably con- 
nected with war, in spite of the scarcity of some and 
the high prices of all classes of food, the English 
civilian death-rate and disease-rate have not only not 
increased during the war, but have actually been 
decreased and brought down to the lowest figure in 
history. 

Such excellent and watchful care has been taken 



18 THE DOCTOR IN WAR 

of the feeding, the hours of work, and the conditions 

of labor of the workers, such special efforts have 

Iteen put forth to safeguard the lives and improve 

x the food and health surroundings of young children, 

that there is good ground for the statement that 

England is actually saving life at home faster than 

it is being wasted upon the field of battle abroad. So 

_ that the population of Great Britain is not only not 

.diminishing, but actually slightly increasing in spite 

of the war. In fact, incredible as it may sound, the 

<total death-rate, both military and civil during the 

last three years, is very little higher than what would 

have been considered an average one in the civilized 

-\ -countries of Europe sixty or seventy years ago.** 

This successful fight against disease and death at 
-home has been greatly helped by one of the curious 
compensations of this war, and that is the extent 
to which it is a war of huge cannon and high explo- 
sives, of engines of destruction, and of machinery 
in every"imaginable form. This means an immense 
demand for factory production of every sort at 
home, with wages to match; indeed, as Mr. Lloyd 
George has stated in one of his speeches, it takes 
- four men and three women in factories and on the 
railroads at home to support and supply one fighting 
man on the line of battle. 

This means that the wealth of the country has 
been distributed and is being distributed increas- 



THE TRIUMPH OF THE DOCTOR 19 

ingly among those who need and deserve it most, 
that the women and children and men unfit for mili- 
tary service at home, instead of being left unem- 
ployed and starving, have had abundance of work 
at the highest wages ever known. Although food is 
high, wages are still higher and the net result of it 
all is that never were the great eighty-five per cent 
mass of the people, the laboring classes, so well fed, 
so well clothed, so well housed and sanitated, and in 
such excellent physical condition as they are to-day. 

What is almost more gratifying, the ruthless pres- _ 
sure and emergencies of war have revealed the fact, 
which we doctors have been preaching for years, 
that the better the workers are fed and housed, the 
shorter, within reasonable limits, their hours of em- 
ployment, the higher their wages, and the more ideal 
the sanitary conditions under which they work, the 
more and better work they will do, and the larger 
profits they will earn for their employers. In fact, 
the interests of employers and employed are not 
different and hostile, but one and identical, and the 
demonstration of this fact has brought a new spirit 
of friendliness and mutual interest and regard for 
each other's welfare into the industrial world, which 
will never die out, but will survive long after the war 
is over and half forgotten. 

One of the most cheering and encouraging aspectsi 
of a visit to the front and the actual fighting line > 



y 



20 THE DOCTOR IN WAR 

is the sense of a whole-souled devotion to a common 
end and of a real community of interest and brother- 
hood of helpfulness, among tens and hundreds of 
thousands of men. It is a real Utopia, a genuine 
democracy, with every effort devoted to a common 
end and the common welfare. If this spirit, return- 
ing from abroad, shall fuse with the new spirit at 
home, as it certainly will, the world will be lifted to 
a higher plane of fairness, of kindliness, and of jus- 
tice, and even the bitter and pitiful losses of this 
deplorable war may prove to have won an adequate 
reward. 



F 



II 

THE REAL PERILS OF WAR 

ROM the earliest dawn of consciousness the 
three most dreaded perils of the race have ever 
been war, pestilence, and famine. And the greatest 
of these is war. Every age has echoed the sobbing 
chant of the Litany: "From battle and murder, and 
from sudden death, Good Lord, deliver us." 

The march of civilization has been one long, bit- 
ter fight against this devil's trinity, and up to about 
a century ago with indifferent success. Then the 
harnessing of steam and the birth of science began 
to make man the master of the elements and the 
gods, instead of their football ; and within fifty years 
more headway was made against these three Furies 
than in fifty centuries before. During the next half- 
century — the past fifty years — this has been sim- 
ply multiplied by five. 

Famine was the first of the hereditary curses to 
go down and be swept off the earth. This does not 
sound remarkable to us now, because we have for- 
gotten that bitter starvation and death by hunger 
were once parts of the regular process of the seasons. 
Famine occurred every winter among savages, every 
three to five years among semi-civilized peoples, and, 



22 THE DOCTOR IN WAR 

on an average, about every fifteen years among the 
most highly civilized nations, until about seventy- 
five years ago. 

It was the deliberate and carefully considered 
statement of one of the greatest English economists, 
sixty years ago, that four fifths of the people of Great 
Britain never in all their lives had had as much as 
they could eat, and never were comfortably warm 
from November to April. Now famine — thanks to 
our steam- won conquest of empires of virgin soil — 
is a thing unheard of and incredible among civilized 
races, i The last flickering horror of it in western 
Europe was the year of the potato blight in Ireland, 
and, in eastern Europe, the year of the corn mildew 
in Russia; though like the rest of the dead and half- 
forgotten plagues of the past, famine has again M res- 
urrected " to play a part in this war and has actually 
claimed more people in Poland, Russia, Armenia, 
and Serbia than the sword or the shell. 

The next to weaken and give ground was the 
plague of the pestilence. That winning campaign is 
such recent history as to be within the memory of 
all; indeed, many of us have borne or are still bear- 
ing a musket in the ranks. The victory is more than 
half- won already ; and the end — the sweeping away 
of all infectious disease and the bringing of two thirds 
of all deaths under two great causes, accident and old 
age — is in sight. 



THE REAL PERILS OF WAR 23 

What have we accomplished against the last great 
enemy of humanity — war? From some points of 
view, painfully little. If we look at the so-called 
leaders of civilization piling up armament on arma- 
ment ; loading war taxes on the backs of the peasant 
and the laborer until they groan beneath the bur- 
den; matching regiment against regiment and dread- 
nought against dreadnought in insane rivalry, which 
has finally burst the bounds of civilization and is 
deluging Europe with blood, we are ready to cry in 
despair that our boasted progress has been but mill- 
ing in a circle, and to echo Browning's despairing 
apostrophe to the Prince of Peace: — 

" Whose sad face on the cross sees only this, 
After the passion of a thousand years." 

Plunged at a moment's warning, by the mad van- 
ity and insensate jealousy of a few hereditary lead- 
ers, into what bids fair to be the bloodiest war of all 
history, it hardly looks as though we could boast our- 
selves of any real superiority over the Huron-Iro- 
quois Confederacy or the age of Attila and Jenghiz 
Khan. 

When we come to look at the actual facts and con- 
ditions of war, however, the manner in which it is 
waged and the circumstances under which its grim 
purposes are carried out, we find considerable ground 
for encouragement. War, of course, is, and in the 
nature of it always will be, exactly what General 



\ 



24 THE DOCTOR IN WAR 

Sherman called it; but even the cheerful pastime of 
slaughtering our fellow men has in the most recent 
wars been carried on with smaller loss of life and 
less suffering and hardship, both to the actual com- 
batants and to the non-combatants in whose ter- 
ritories the war has been waged. 

It, has taken a smaller percentage of dead and 
wounded to decide the fate of a battle. The actual 
losses in battle have grown steadily less in each suc- 
cessive century, and the total death-rate of the most 
recent wars has been barely a fifth of what it was 
a century ago. The average death-rate of the first 
three great wars of the past century — the Napole- 
onic, the Mexican, and the Crimean — was 12.5 per 
cent a year; that of the last three wars — the Span- 
ish-American, the Boer, and the Russo-Japanese — 
was 4.8 per cent; that of the present so far is about 
3 per cent. 

How has this unexpected change and remarkable 
improvement been brought about? At first sight the 
fact itself will probably be called sharply in ques- 
tion and seem almost incredible. The burden of the 
song of the modern advocates of peace is that ow- 
ing to the fiendishly ingenious improvements which 
have been made by science in our implements of 
slaughter — dynamite shells, rifles that kill at ten 
times the old range, cannon that hurl a ton at a shot, 
Maxims and Nordenfelts that pour bullets like a 



THE REAL PERILS OF WAR 25 

stream from a fire hose — war has become so hor- 
ribly deadly, so cataclysmic in its destructiveness, 
that human spirit and flesh and blood can no longer 
endure it. 

Here we go at it since 19 14, however, as coolly and 
recklessly, though not quite so cheerfully and light- 
heartedly, as they did in 141 9. The reason is that 
the same brain which invented these killing-machines 
has to some extent devised means for neutralizing 
or evading their deadly effects. A battle may be 
fought to-day with high-velocity bullets, the latest 
field artillery, lyddite or cordite shells, dynamite 
mines, and pom-pom machine guns capable of mow- 
ing their way through the trunk of a tree, and de- 
cided with less than half the loss of life that it cost 
in the days of the arrow, the javelin, and the spear, 
or in those of the flintlock and the sabre. 

That this striking decrease in the fatality of war 
has actually occurred is as abundantly attested as 
any fact of history; for, since the time when anything 
approaching accurate records have been kept of battle 
losses, each century has shown a steady and constant 
lowering of the number killed and wounded in pro- 
portion to the forces engaged. But the history of 
the battles now being fought has still to be written. 

In the days of Agincourt, for instance, when the 
issue was decided by showers of arrows at fifty paces, 
or by sword, spear, and battle-axe, breast to breast 



26 THE DOCTOR IN WAR 

and hand to hand, the average loss in killed and 
wounded was anywhere from fifteen to thirty per 
cent of the forces engaged ; in fact, in those days the 
soldier who came out of a seriously disputed battle 
between anything like equal forces without some 
kind of wound was looked on with considerable sus- 
picion as to his courage or his fidelity. 

After the introduction of gunpowder, — which, 
paradoxical as it may seem, has been one of the 
great life-saving forces of history; first, by deciding 
battles at long range; second, by breaking up and 
wiping out of existence the baron's castle and the 
walled and fortified town; and third, by making 
civilization permanent, eternally superior to savage 
attack, Goth, Vandal, or Hun, — though much 
larger armies were brought into the field and cam- 
paigns conducted on a far more extensive scale, the 
actual percentage of losses fell distinctly. 

By the time the Napoleonic wars were reached the 
death-rate in war from all causes had fallen to about 
one hundred and twenty-five per thousand a year, 
or about twelve per cent. In our own Civil War it 
fell to ten per cent. The Sedan campaign cost the 
German army only eight per cent of its three quarters 
of a million men; while our Spanish-American War 
and England's Boer War reached the low-water 
mark, with barely three and four per cent of loss 
respectively. 



THE REAL PERILS OF WAR 27 

As to the cause of this gratifying reduction in war 
fatalities, several influences have been at work. One 
of the most obvious has been that the invention of 
gunpowder and the improvement of rifles and artil- 
lery, with such enormous increase in their range of 
death-dealing, has steadily forced more and more of 
the fighting to be carried on at long range. 

The net result of this has been that not nearly so 
many men are actually hit as in the days of old 
point-blank firing by platoons; that as a battle be- 
comes a long-range duel, directed by field-glasses, 
heliographs, and telephones, its fate is decided more 
and more by maneuvers such as surrounding a force 
or cutting it off from its base than by actual sacri- 
fice of life or by weight of numbers in a bayonet 
charge. That both these influences are at work and 
have operated in this direction is unanimously ad- 
mitted by all military experts and supported by con- 
vincing proof. 

' In the first place, the weight in lead or shells which 
has to be fired from rifles or cannon in order to kill 
a single soldier has markedly increased within the 
last fifty years. The old saying used to be that every 
bullet had its billet. Then, twenty or thirty years ago, 
this was changed to the statement that for every man 
killed his own weight of lead or iron in the shape of 
bullets or shells had been fired. In the last official 
slaughter but one — the Balkan War — a Belgian 



28 THE DOCTOR IN WAR 

surgeon, Dr. Laurent, who served with the Bulgarian 
army, calculated the actual expenditure of ammuni- 
tion compared with the number of Turks killed, and 
found that there were one hundred and ten rifle balls 
and ninety shells and shrapnel fired for each dead 
Moslem. While in this present war it is estimated to 
take nearly two tons of shells and explosives to kill 
one enemy soldier. 

The other most important change, due to the new 
methods of fighting since the use of gunpowder and 
long-range weapons, was that in the old days, when 
battles were decided by hand-to-hand fighting, the 
victors were literally right on top of the vanquished 
the moment the tide turned and the retreat began; 
and only superior fleetness of foot or length of wind 
could save a very large percentage of the beaten troops 
from slaughter, maiming, or slavery. 

By far the most important and influential factor, 
however, in denaturing and taking the curse off war 
has been the advance in medical science. This may 
seem, at first sight, an extraordinary if not extrav- 
agant > statement ; for even the most enthusiastic 
champion of medicine will admit that, with all our 
progress, we have never been able to raise the dead, 
or do much to restore the man who has had his head 
taken off by a cannon ball or been blown to pieces 
by a shell. Doctors may cure diseases, but they can- 
not do much to remedy sudden death. 



THE REAL PERILS OF WAR 29 

This incredulity, however, is simply due to a mis- 
understanding of the facts. Naturally enough, since 
the main business of war is the slaughtering or dis- 
abling of the enemy, we have taken it for granted 
that the chief risk of warfare is that of death in bat- 
tle. As a matter of fact, battle is one of the least of 
the perils of war; for until within the last forty or 
fifty years the loss in battle and by wounds has never 
been more than a fifth as great as the loss resulting 
from disease. In Napoleon's Peninsular campaigns, 
for instance, of four hundred and sixty thousand men 
lost, only sixty thousand fell in battle — that is to 
say, in bloody war disease caused from five to twenty- 
five times as many deaths as the sword or the bullet. 
And the real horror of war is fever. The whimsical 
paradox holds that, by cold figures, soldiers are safer 
on the battle-field than in camp, though not in pro- 
portion to the time spent there. 

Four fifths of the slaughter in war has in the past 
been due to disease, and at least ninety per cent of that 
disease is preventable; in fact, it has already been 
prevented in one epoch-making modern instance — 
among the Japanese in the Russo-Japanese War, where 
the death-rate from disease was barely two per cent. 
Improvements and progress since then have put us in 
a position to cut in two even that low rate and reduce 
it to one per cent a year, or the same as that of a simi- 
lar body of men engaged in peaceful occupations. 



30 THE DOCTOR IN WAR 

Even the direct and necessary fatality from deaths 
in battle and from wounds has been tremendously 
reduced by medical science. Though those who are 
killed outright, or are so terribly torn and mangled 
that they die from shock or hemorrhage within a 
few hours, are, alas! beyond our skill, these consti- 
tute barely half of the total deaths from battle; in 
fact, when we first begin to study the figures we get 
the gruesome impression that war is becoming dead- 
lier, because a so much larger percentage of the lost 
are killed outright or die on the field. 

In an earlier day the proportion used to run: five 
thousand killed in battle; seven, ten, or twelve thou- 
sand died of wounds. About fifty years ago the pro- 
portions became about even. In our Civil War the 
deaths on the battle-fields forged ahead — namely, 
sixty-seven thousand, while only forty- three thou- 
sand died of wounds. In the Franco-Prussian War, 
on the German side seventeen thousand were killed 
outright and eleven thousand died of wounds; while 
in the Russo-Japanese War forty-seven thousand 
Japanese fell in battle and only eleven thousand died 
of wounds, making the proportions over four to one. 
In the first Balkan War the figures ran thirty thou- 
sand to twelve thousand. 

The briefest hospital experience will explain this 
paradox. There are as many wounded in proportion 
to the killed outright as before; only, instead of from 



THE REAL PERILS OF WAR 31 

twenty to fifty per cent of the wounded dying from 
their wounds, as in the old days of hospital gangrene, 
tetanus, and erysipelas, in these days of antiseptic 
surgery, from ninety to ninety-five per cent of the 
wounded recover. 

To put it briefly, judging from the statistics of 
recent warfare the chances of the modern soldier's 
being killed in battle in a year's campaign have been 
reduced to about one in thirty ; his chances of dying 
of wounds received in battle to about one in sixty; 
his chances of dying of disease to less than one in 
a hundred. How this compares with an earlier day 
may be illustrated by one concrete average instance: 
In the Russo-Turkish War of 1828, out of an army 
of one hundred and fifteen thousand Russians who 
crossed the border, not more than fifteen thousand 
ever returned to Russia, after serving in only two 
campaigns. 

One of the interesting by-products, as the chem- 
ists say, of this transformation of warfare is the 
striking diminution in suffering, agony, and discom- 
fort of those who actually become food for powder. 

It is, of course, obvious that those who are killed 
instantly on the field of battle mercifully suffer no 
pain; and consequently the larger the percentage of 
such deaths in the total number of fatalities the 
less the actual agony and suffering endured. The 
old prayer to be delivered from sudden death had Jt 



32 THE DOCTOR IN WAR 

wrong. It is from every point of view the best form 
of death there is — though we are not anxious to 
have Gabriel call us any earlier than necessary. 

In the second place, the greater part of the pain 
and suffering and agony produced by wounds comes 
not at the time of their infliction, or within six or 
eight hours thereafter, but when they begin to fester 
and suppurate and inflame. This we used to call, 
in our innocence, the process of healing; now we 
know it to be the onset of infection. 

It is difficult to make any one who has not had 
actual experience, either as a surgeon or as a patient, 
believe it; but it is, nevertheless, a merciful fact 
that the severest and most serious injuries or wounds 
often cause astonishingly little pain at the time of 
their infliction. A broken leg or a broken arm, for in- 
stance, eight times out of ten causes little or no pain. 
Thousands of cases are on record where a man has 
had his leg broken in a railroad wreck, or runaway 
accident, or factory smash, and has never known 
that it was broken until he tried to move it or to 
walk on it. The same is true of bullet wounds. Many 
a soldier in a bayonet charge has suddenly plunged 
headlong, feeling as though one leg had gone numb, 
or supposing he had tripped or stumbled; and when 
he tried to rise has found the bone shattered by a 
bullet. 

On the other hand, many wounds, not at all dan- 



THE REAL PERILS OF WAR 33 

gerous to life or even temporarily disabling, are 
agonizingly painful simply because the injury has 
been just severe enough to tear or graze or lacerate 
the nerves, but not sufficiently crushing or stunning 
to numb and paralyze them. This is not, by any 
means, to say that to be wounded in battle is a tri- 
fling and painless amusement; but only that a con- 
siderable percentage — from fifty to seventy would 
not be too large an estimate — of the more serious 
wounds, and a still higher percentage of the mortal 
ones, are attended with comparatively little serious 
or agonizing pain. 

In war, as in the sick-room, the ability to feel acute 
pain is a sign of life and resisting power; and so long 
as our patients are actually afraid they are going to 
die, or are making audible complaint of their suffer- 
ings, we seldom feel uneasy about the outcome. It 
is when they begin to lose interest in whether they are 
going to get better or not, or lie wide-eyed, without 
uttering a word or making a sound, that we feel the 
situation is serious. Either disease or wounds that 
are serious enough to prove fatal or to put life seri- 
ously in peril carry, for the most part, — most mer- 
cifully, — their own anaesthetics with them, by either 
crushing or poisoning the nerve-trunks until they 
are unable to report pain. 

Should a bullet or bayonet wound prove fatal, the 
nerves never recover consciousness, so to speak; but 



34 THE DOCTOR IN WAR 

in those of lighter character, from which the patient 
is able to rally as soon as strength and consciousness 
begin to return, the nerve-trunks wake up with the 
rest of the body, and a period of intense boring or 
burning pain follows. This, however, can usually be 
kept fairly within bounds by an opiate and in any 
severity lasts only until the tissues begin to heal 
— that is to say, anywhere from six to forty-eight 
hours. 

The time when wounds really begin to hurt is 
from thirty-six to seventy-two hours after their in- 
fliction, when suppuration or inflammation sets in. 
This swelling and burning and throbbing with a 
profuse outpouring of matter or pus — pus lauda- 
bile, " praiseworthy matter," as it was called — used 
to be regarded as part of the regular process of heal- 
ing; but since the days of Lister we have discovered 
that, instead of being a part of healing, it is a purely 
mischievous and injurious process due solely to in- 
fection with one or the other of the so-called pyogenic 
or septic germs, usually streptococci or staphylo- 
cocci. Keep these out of the wound, and inflamma- 
tion, with its throbbing agony and fever and horrible 
discharges, will be entirely avoided. 

Easily two thirds of the pain and suffering en- 
dured by the wounded in war is not due to the wounds 
themselves or to the process of healing, but to sup- 
puration and infection; and all this has been wiped 



THE REAL PERILS OF WAR 35 

out by antiseptic surgery. What military hospitals 
were like in the pre-antiseptic days beggared de- 
scription, and can hardly be imagined even, let alone 
believed, at the present day. 

Marlborough's surgeon in the famous Blenheim 
campaign declared that hospitals were the most im- 
portant cause of death. And a famous French sur- 
geon in 1 74 1 declared that he had known vastly more 
men to die in the hospitals from lack of care than to 
lose their lives in combat; and that "hospitals are 
an unfathomable gulf; the source of their horrors 
appears to be inexhaustible.' ' Two patients in each 
bed was the rule and often three or even four. The 
hospitals were literally breeding-places for disease. 
The deadly typhus fever used to be known as " hos- 
pital fever"; while typhoid, dysentery, erysipelas, 
and gangrene fairly ran riot in them. Browning's 
characterization of the mediaeval hospital, as " that 
good house that helps the poor to die," was painfully 
accurate. 

Even as late as our Civil War, when the dreaded 
hospital gangrene once put in an appearance in a 
ward it was a sentence of death to be sent into that 
ward with an open wound; and in some instances 
from forty to sixty per cent of all the inmates actu- 
ally died. Up to, and, indeed, during, the Napoleonic 
wars anywhere from twenty to sixty per cent of the 
wounded died. To-day any army medical service 






36 THE DOCTOR IN WAR 

that loses more than five or six per cent of its wounded 
considers itself disgraced. 

The methods by which these wonderful savings of 
life and suffering have been accomplished, the tri- 
umphs of antiseptic surgery, need no description; 
for they are common knowledge, as well as one of 
the wonders of the age. The strictest and most scru- 
pulous cleanliness, the boiling of instruments, and 
cleaning of surgeons' and nurses' hands — these are 
practiced in every hospital and taught to the rising 
generation in our schools. 

The importance of one point, however, is not yet 
fully recognized, and that is the part played by the 
individual soldier himself. To see that the instru- 
ments and the dressings, the operating-room and 
the hands of the surgeon are surgically clean will 
cut off three fourths of the risks of infection; but 
there is a very important zone of danger, amounting 
to quite twenty-five or thirty per cent, which has to 
be crossed before the surgeon ever sees the wound; 
and that is the first-aid dressings and their use by the 
soldier himself or his comrades. 

You cannot always choose a nice, clean, antisep- 
tic place for a battle; and we now know that the 
bacteria of the soil, particularly if the soil be culti- 
vated and fertilized with various decaying vegetable 
and animal substances, may set up serious trouble 
if they get into wounds. Not only so, but there are 



THE REAL PERILS OF WAR 37 

also bacilli that make themselves more or less at 
home on the surface of the human skin and in the 
pouches of the hair follicles which, if they get into 
an open wound, may set up suppuration. It is, there- 
fore, a matter of first importance that a soldier in the 
field should keep himself and his clothing — par- 
ticularly his underwear — in as clean, thoroughly 
washed, and well-ventilated condition as possible. 

It is particularly desirable before going into battle 
to put on a suit of clean underwear, so that if any 
strands or threads of clothing are carried into a wound 
by a bullet they will not carry germs with them. One 
of the reasons why the sea-fighters of Nelson's day 
used to strip themselves naked to the waist when 
they served the guns was that they had discovered 
by painful experience that a splinter or shot which 
carried with it into the wound a fragment of dirty 
and sweat-soaked clothing added hugely to the risk 
of painful and dangerous suppuration. 

In all modern armies now the soldier is provided 
with one or, in some cases, two packages of first- 
aid dressings. These are wrapped up in oiled paper 
or oiled cloth, so as to be protected from moisture, 
dirt, or the penetration of perspiration if carried in 
pockets or knapsacks. The moment a wound is re- 
ceived the sufferer, or one of his comrades, cuts away 
the clothing, tears open the package of dressing, ap- 
plies the pad of cotton or gauze to the wound, and 



38 THE DOCTOR IN WAR 

binds it on firmly with the bandage. Unless an ar- 
tery of considerable size has been injured the pres- 
sure from the dressing soon arrests the hemorrhage, 
and the blood clots and dries all over the surface of 
the wound and round the edges, so that rifle wounds 
are perfectly sealed against all dirt from the soil or 
from the hands of the sufferer or from air and dust. 

The success of this immediate-dressing method is 
assisted by the character of the wounds made by 
the high-velocity bullets. These whirl through the tis- 
sues at such a tremendous rate of speed that they 
pulverize and almost cauterize the edges of the 
wound, so that the bleeding from it, unless a large 
artery be actually torn across, is often astonishingly 
slight. 

Another advantage of the modern high-velocity 
bullets is that the wounds they make are almost 
absolutely sterile. The reason for this is that the 
tremendous force and speed with which they are 
driven through the grooves of the rifle barrel njise 
them to such a heat by friction that any accidental 
germs that might have become attached to them as 
a result of their being dropped on the ground, or car- 
ried in dirty pockets, or handled with infected fingers, 
are either scraped off or destroyed; in fact, most 
fortunately, the modern bullet, like the flatiron Bert 
Williams left home just six inches in front of, has 
" nurnn whatever attached to it — but speed! " 




A WOUNDED FRENCH SOLDIER RETURNING ON FOOT TO THE 
DRESSING-STATION 



THE REAL PERILS OF WAR 39 

On the whole, though this was by no means the 
intention of their inventors, the new high-velocity 
bullets are more humane and less pain-producing 
than the old-fashioned round ball or soft bullet. The 
latter, if it happened to strike a bone, would some- 
times spread in the most horrible fashion and tear 
through the tissues as though a crowbar had been 
driven through them. 

The infamous dumdum bullet, in fact, is a hard 
metal bullet with a soft perforated lead tip or nose, 
intended to mushroom in this ghastly fashion when- 
ever it strikes a bone. The new high-speed bullets, 
on the contrary, drill their way through the soft 
tissues almost as cleanly as a red-hot bradawl. 
| . Early in the war, in Belgium, one of the German 
prisoners presented an arm to be dressed which he 
thought had been slightly grazed, but which on 
examination proved to have been drilled completely 
through by a bullet. It had fortunately missed the 
bone and arteries, and so produced no hemorrhage 
whatever, leaving only a little, clean-cut, black-and- 
blue-edged hole in the skin on the front and on the 
back of the arm, where it went in and came out again. 

The behavior of these high-speed bullets when 
striking bones, however, is very uncertain. In not a 
few cases they will drill right through an arm or leg 
bone without even cracking it, making as clean-cut 
a hole as a drill or a trephine. In other cases, how- 



40 THE DOCTOR IN WAR 

ever, particularly in wounds of the skull, they will 
shatter the bone for five or six inches in every di- 
rection, as a window pane is shattered by a stone, 
and do exceedingly serious damage. They may also 
strike some obstacle, or ricochet from the ground, 
bend into a crescent and strike sidewise, with ghastly 
smashings and tearings. 

On the whole, however, when these bullets kill, 
they kill suddenly and painlessly. The wounds are 
followed by little hemorrhage and by less pain than 
those inflicted by the old-fashioned bullets; the risk 
of suppuration is less; and they heal in from one half 
to two thirds of the time required by other wounds. 
Oddly enough, they have one peculiar disadvantage 
— from the fighting-man's point of view: they will 
not stop a charge, particularly a rush of savage or 
barbarian fanatics, so well as the old-fashioned, soft- 
lead bullets ; because the shock when they strike the 
body is not nearly so severe. But, alas, in this war 
eight tenths of all wounds are from shell fragments 
which are as vicious and filthy as bullets are mild 
and clean. 

The lion's share of the saving of life in war has 
been in the prevention of sickness on the field and 
in the tented camp. We are not yet able to say that 
war itself is a disease and preventable, though we hope 
that that day may come; but we can say that four 
fifths of its mortality, as waged in the past, was due 



THE REAL PERILS OF WAR 41 

to preventable disease; and that disease is not only 
preventable, but is being actually prevented in most 
modern armies. 

The sanitary conditions in the field up to the mid- 
dle of the nineteenth century were something appall- 
ing. In the Thirty Years* War, from 1618 to 1648, 
all Central Europe was turned into a pesthouse; 
and, though less than sixty battles were fought in the 
thirty years, army after army melted and disap- 
peared, from typhus, from dysentery, and the Black 
Death, from famine, from food poisoning, smallpox, 
and cholera. 

The great Gustavus Adolphus, after one deadly 
winter in quarters, found himself practically with- 
out an army, and lost during the winters rest more 
than ten times as many men as during the summer's 
campaign. .There was no drainage, no vaccination, 
no method of preventing the spread of infection. 
There were no surgeons or medical corps, though a 
few of the generals and noblemen took their private 
surgeons into the field. 

EvdT this painfully inadequate attempt to care 
for the wounded dates back only to the fifteenth 
century, in the campaign of Agincourt and the army 
of Henry V, five hundred years ago. The great pio- 
neer of military surgery, Ambroise Pare, discovered 
on the field of battle the superiority of the silk-thread 
ligature to the cautery or hot iron for checking hem- 



42 THE DOCTOR IN WAR 

orrhage; but he served only in the capacity of pri- 
vate physician to the Duke of Guise. In the light 
of recent events it sounds like the echo from some 
nightmare to note that the campaign in which he 
made this famous discovery was the siege of Metz 
in the sixteenth century. 

Even two hundred years later Frederick the Great 
declared that fever alone cost him more than seven 
great battles. This was hardly to be wondered at when 
we remember that, although there were regimental 
surgeons, they were very poorly equipped, and, what 
was still worse, were almost entirely unprovided 
with hospitals or nurses. Incredible as it sounds, 
hospitals were not considered a necessary part of 

/ army equipment until the time of Louis XIV. Vol- 

< 

taire describes these new and wonderful provisions 
of humanity as they were conducted in 1707 — 
again with a distressing reminder of a modern in- 
stance — at the siege of Lille. 

Napoleon cared very little for his sick and wounded. 
He simply threw them into barns, outhouses, village 
hovels, or peasants' huts, left them L there and swept 
on; but it was during his disastrous wars that the 
first clear instance of a really effective, working army 
medical service appeared, and that was in the Eng- 
lish army under Wellington in the Spanish Penin- 
sula. It was crude and imperfect, according to mod- 
ern standards, but it kept down the disease death- 



THE REAL PERILS OF WAR 43 

rate to a little more than half that of the French 
army. The fact made such an impression that even a 
military historian was struck by it, declaring that 
the work of the army surgeons had probably prac- 
tically decided the result of the crucial battle by 
adding a full division to the strength of Wellington's 
army. A century later the Japanese deliberately 
calculated that they could neutralize Russia's supe- 
rior numbers by keeping fifty per cent fewer men in 
the hospital. 

The sanitarian is a powerful factor in modern war, 
though he gets few medals or promotions for it. The 
lesson appeared to have been soon forgotten, how- 
ever, for in the next serious war — the Crimean, in 
1854 — tne English troops went into the campaign 
so badly equipped that their disease death-rate rose 
to the enormous figure of twenty-three per cent a 
year — more than four times as great as the battle 
death-rate. Thirty per cent of their eighty thousand 
men perished in the first campaign. Fortunately 
this horrible loss recalled them to their senses. A 
sanitary system was organized and equipped, at the 
head of which Florence Nightingale won her immor- 
tal fame. Camps were properly policed; food-sup- 
plies were improved ; good hospitals were established ; 
and the disease death-rate of the second summer 
campaign was reduced to less than a tenth of the 
first. 



44 THE DOCTOR IN WAR 

It was most significant that the first great victory 
in our permanent triumph over disease in war was 
won by woman; and she has been repeating the per- 
formance ever since; the nursing service, the Red 
Cross, the ambulance, and the field hospital would 
be impossible without her. Her courage and her de- 
votion are equal to that of the fighting-man, for she 
actually faces the deadliest risks of war — disease, 
poor food, bad water, and privations. 

And when the hospital comes under fire she goes 
aoout her duties unflinchingly, as steady as a vet- 
eran of the Old Guard. She hates war, not because 
she is afraid of blood, — there has been more blood 
shed bravely in the birth-chamber than on the field 
of battle, — but because she sees it for what it is. 
She is becoming more and more an influence to be 
reckoned with. 

Woman has done wonders toward humanizing war 
— some day she will abolish it altogether. Our own 
American Civil War profited by this terrible experi- 
^-ence; and, though coming only seven years later, 
succeeded in cutting the Crimean death-rate almost 
in two. 

Finally, in the Franco- Prussian, the Spanish- 
American, and Boer Wars, the lowest death-rate 
from disease yet recorded was attained — that is, 
two and a half per cent. Even the brilliant and mag- 
nificent work of the Japanese medical corps in the 



THE REAL PERILS OF WAR 45 

war with Russia did not succeed in lowering this 
average more than a fraction of one per cent. Its real 
triumph lay in the fact that, instead of the war be- 
ing waged, like most of our own Spanish-American 
War or the Franco-Prussian War, in civilized and 
temperate countries — four fifths of our war loss 
was on our own soil — • it was waged in a densely 
populated, half-civilized country, reeking with filth, 
with scarcely a stream free from typhoid contami- 
nation, and sown from one end to the other with 
typhoid, typhus, smallpox, cholera, and the great 
Black Death itself in its most virulent form. To win 
under those circumstances a disease death-rate for 
an army of three quarters of a million men, for nearly 
two years, of barely two and a half per cent, equal- 
ing that of the Germans in their brief four months' 
campaign in one of the healthiest countries in Europe, 
was a triumph of which the Japanese medical corps 
is entitled to be proud. 

The Japanese were the first openly to adopt the 
rule that the doctor's place is in the first line of the 
advance guard, with the scouts and cavalry patrols. 
Every well was tested and labeled hours or days 
before the main army reached it; and if infected it 
was guarded by a sentinel with fixed bayonet. Every 
village was rigorously inspected, cesspools disin- 
fected, and all cases of infectious disease quaran- 
tined. Food brought in by foragers was examined 



46 THE DOCTOR IN WAR 

with the microscope and tested with reagents before 
it was used. Mosquito pools were kerosened, camp- 
grounds selected in advance and, if necessary, 
drained. Nothing was left to chance. 

We had, indeed, good reason to reproach ourselves 
for our unnecessary waste of life in the Cuban cam- 
paign of our Spanish War, but this was solely on the 
ground that of the fifty-four hundred deaths from 
disease, nearly four fifths died on our own soil from 
one preventable disease — typhoid fever. 

Our work in the Philippines was admirable, and 
our total death-rate from sickness during the whole 
war was small, — one of the lowest in history, — ■ 
though, by contrast with the fact that it was more 
than five times as great as our losses in battle, it 
caused us much reproach and heartburning. 

Our death-rate in battle, however, owing to the 
fewness of actual engagements and the guerrilla war- 
fare that made up most of the campaign, was the 
lowest in recorded history — less- than a half of one 
per cent. 

Though we in America have had no wars since 
then till now, we have been able to assure ourselves 
of the high standard of efficiency reached by our 
medical and sanitary army corps against the dread 
enemy of the soldier, disease, by maintaining two 
armies in the field, each for a considerable period 
of time. 



THE REAL PERILS OF WAR 47 

One of these was the army of observation encamped 
along the Mexican frontier during the whole sum- 
mer of 1912. It was placed in much the same cli- 
mate and circumstances — if anything slightly more 
unfavorable on account of the heat, poor water-sup- 
ply, and infection from Mexican villages — as our 
army in Florida during the Cuban campaign. For- 
tunately for purposes of comparison the numbers 
happened to be almost identical — something over 
twenty-five thousand men in Florida in 1898 and 
about thirty thousand in Texas in 191 2. The death- 
rate from disease in Florida for the season was two 
and a half per cent; that in Texas was about two 
thirds of one per cent. 

A large share of this splendid reduction was due 
to the difference in one factor, typhoid fever, which 
caused something like eight tenths of the deaths 
that occurred in Florida, whereas of the thirty thou- 
sand troops in Texas only three men died of typhoid ! 
The reason for this was medicine's latest and well- 
nigh greatest contribution to the saving of life in war- 
time — the discovery of a vaccine or protective in- 
oculation against typhoid fever. Three injections 
of this at intervals of about ten days will diminish a 
man's chances of contracting typhoid, under the 
most unfavorable circumstances, to about one in a 
thousand for a period of from two to five years, and 
possibly longer. 



48 THE DOCTOR IN WAR 

The other sanitary triumph of our American army 
medical corps was the occupation of Vera Cruz. 
Thirty-five thousand men landed and took posses- 
sion of a hostile city in the famous tierra caliente of 
Mexico, reputed to be one of the deadliest climates 
in the world and at the most unhealthy season of the 
year. The town reeked with malaria and was full of 
smallpox and dysentery. An active mosquito war 
was begun at once and the weapons used were kero- 
sene, quinine, and ditches. Four fifths of the na- 
tive population of sixty thousand were vaccinated 
within two months, with the result that both malaria 
and smallpox practically disappeared. 

The city was cleaned, drained, and its water- 
supply purified, with the amazing result that, of 
thirty-five thousand soldiers, only one died of disease 
in three months; and the death-rate of the native 
population was cut in two. War no longer brings 
in its train famine and pestilence. Almost the only 
soldiers sick were those on outpost duty, exposed 
to flies and mosquitoes from Mexican territory. 

These are fair illustrations of one of the most en- 
couraging aspects of our great reduction of the death- 
rate in war — that its victories are won against the 
same enemies which cause our heaviest death-rate 
in time of peace. 

From the point of view of disease, war brings no 
evils in its train, but merely aggravates and exag- 



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THE REAL PERILS OF WAR 49 

gerates by its overcrowding, poor drainage, under- 
feeding and exposure to wet and cold in temperate 
zones, and to the winged pestilence that carries 
malaria and yellow fever in tropical climates — the 
same diseases that mow us down in the times of 
peace. So the lessons learned on the tented field can 
be carried back and applied in the village and the 
town in the peaceful country. 

In fact, we have recently been given one brilliant 
and superb demonstration of what can be done in 
peaceful enterprises, by carrying out the methods of 
military sanitation, in the triumphant building of 
our Panama Canal. We have already reduced the 
death-rate in the bloodiest war to less than half of 
that of absolute peace two hundred years ago. 
* Now, by the application of military methods to 
peaceful enterprises we have succeeded in lowering 
the death-rate of a body of over thirty thousand men 
and women — yes, and children — not merely in the 
tropics, but in'the deadliest and most sweltering pest- 
hole in the civilized world and in all history, the 
Isthmus of Panama, to a little more than half of one 
per cent a year, which is less than half the death-rate 
of the entire population of the United States. 

Of course, it was a picked group of strong, vigorous 
workers — both men and women — who had passed 
rigid physical examinations ; but it is safe to say that 
it was a fair sample of what might be done for the 



50 THE DOCTOR IN WAR 

entire population of any State in the Union if Gen- 
eral Gorgas were given there the same free hand he 
had in Panama to feed, house, and protect from in- 
fection. 

War is horrible and will always remain so; but we 
have robbed it of some of its terrors within the last 
century. The next step should be to wipe it out alto- 
gether. 

Modern war is forty per cent engineering, fifty per 
cent sanitation, and the rest strategy. An army, as 
Napoleon said, is like a serpent — it travels on its 
belly. Put your men on the fighting line in good 
health and in fair numbers, and, as Sherman said, 
"You need have no fear but they'll fight." 

The whole science of war, as Forrest, the famous 
Confederate cavalry chief, pithily remarked, is "get- 
ting the mostest men there the fustest." The two 
things that most powerfully promote this result are 
transportation and sanitation. Other things being 
equal, the army that has fewest men in the hospital 
will win most battles. 

An army with good doctors has a thirty per cent 
advantage over one with poor ones. Can the same 
oe said of generals? 



Ill 

FEEDING A MILLION MEN 

What the Soldier eats 

HOW a soldier will fight depends, first, on how 
he is armed, and, second, on how well he is fed. 
We hear a great deal about warlike and unwarlike 
races, about mild and peace-loving nations, and 
famous fighting strains; but almost any race, how- 
ever tall or short, dark or fair, savage, half-savage, 
or civilized, if well fed, fairly armed, and halfway 
decently led and trained, will furnish a pretty fair 
article of fighting men, quite good enough for all 
practical purposes of warfare, whether mediaeval or 
modern. Courage, like most other good things, is 
one of the most frequent of human virtues, and will 
come to the surface as soon as it is given a decent 
physical basis on which to stand. From the days of 
the Foreign Legions of Rome and the Janizaries of 
Constantinople to England's Ghurkas and Sikhs and 
France's Turcos and Senegalese, the dominant race 
has turned painted and nose-ringed^savages into first- 
class fighting machines. 

Even out of the most peaceful and sheeplike of 
races, like the Chinese coolies, Gordon was able, in 
three years, to form his famous Ever Victorious 



52 THE DOCTOR IN WAR 

Army, which never fought against odds of less than 
three and usually ten to one, but was never defeated, 
and which he expressed his perfect willingness to 
match against an equal number of any known Euro- 
pean line regiments. 

Explanations of the transformation have been 
varied and superficial — ■ military drill, according to 
one opinion; superior weapons, to another; confidence 
in white officers, to a third. But the deliberate judg- 
ment of competent experts is that half the miracle 
was wrought by better food. That was Gordon's own 
explanation of the major part of his triumphant feat. 

An army in the field seems to rest solidly on the 
ground ; up to its knees in it, in fact, if the rains have 
been heavy. Practically, however, it is up in the air, 
supported by a tripod, one leg of which is ammuni- 
tion; another, rations; and the third, sanitation. 
Knock any one of those legs from under it, and it 
goes down, flop, like a bird with a broken wing. 

We hear much of the tremendous problem of mo- 
bilizing an army, of assembling and entraining troops, 
and massing them on the frontier in three, five, or 
seven days from the declaration of war. It is a tre- 
mendous and difficult feat; but it is merely a sum- 
mer holiday compared with the exhausting and 
never-ending problem of feeding them after getting 
them there, which becomes still more difficult as they 
march into the enemy's country. 



FEEDING A MILLION MEN 53 

It requires a tremendous number of troop trains 
to deliver an army of two hundred thousand men on 
the fighting line; but when that has once been done 
it is over and seldom needs to be repeated on the 
same scale, fractional units only, as a rule, being 
moved at intervals of several weeks or months. 

Each of those two hundred thousand men, how- 
ever, eats his own weight in food every thirty days; 
and that means a never-ending succession of freight 
and supply trains, pouring constantly backward and 
forward all day and all night, as long as the war lasts. 
And there can be absolutely no let-up in this toil- 
some service, no excuses for breakdowns, no breath- 
ing-spells or vacations. That rumbling, lumbering, 
never-sleeping line of communication is the very 
aorta of an army — the great artery through which 
pours its life-blood. 

In the early days the problem of rations was a 
comparatively simple one, for each soldier supplied 
himself, carrying enough at his saddlebow or in his 
haversack to last him until he got into the enemy's 
country, when the rest was easy. War, in the be- 
ginning, was systematized robbery and plunder; and 
it has not changed much even in this twentieth cen- 
tury. The principal inducement to go to war was 
the excellent excuse it gave for plundering and loot- 
ing, and living off the country generally. 

So vitally important is food to an army that any- 



54 THE DOCTOR IN WAR 

thing which hinders a soldier from utilizing to the 
full his ration disqualifies him at once. In modern 
recruiting offices more applicants are rejected to-day 
for defective teeth than for any three other defects. 
This seems little short of absurd to the non-expert, 
and one can hardly help sympathizing with the re- 
cruit who a few weeks ago volunteered for service in 
England. He was a bony, sturdy Scot and could 
hardly believe his ears when told he was rejected. 
The examiner regretfully explained that the only 
cause was his decayed teeth. Fixing a dark and re- 
proachful gaze on the officer, he exclaimed: — 

"Mon, yeV makkin' a gran' mistak'. Ah'm no 
wantin' to bite the enemy, ah want to shoot 'im!" 

Moreover, wars were formerly casual, fitful affairs, 
and lasted only so long as the food-supply of the 
invader and invaded held out, then collapsed of their 
own accord. In those days the best soldier was the 
man who could go longest without food or live on 
the coarsest and cheapest foodstuff. The inhabi- 
tants of the rich plains and fertile valleys were per- 
petually being harried by swarm after swarm of hill- 
men and mountaineers, caterans, moss-troopers, 
night-riders, and banditti, who came down, hungry 
and steel-clad, out of their wretched fastnesses once 
or twice a year for a square meal. 

The earliest commissariat started, for obvious 
reasons, with a decidedly restricted, solid — not to 



FEEDING A MILLION MEN 55 

say stodgy and unattractive — group of food fuels. 
Foods, to be suitable for army supplies, must, of 
course, be of proved and high nutritive value. They 
must be as compact as possible — that is to say, have 
as much nourishment for their bulk and weight as 
feasible, so as not to cost too much for transportation. 
And they must be in such form as to keep well and 
stand considerable variations of climate and vicissi- 
tudes in handling and storing without spoiling. 

Naturally a few pieces de resistance, as the French 
call them, poked their heads into the limelight at 
once — salt meats, particularly beef and pork; hard 
biscuit; flour, beans, and fat. The judgment that 
selected these staples was sound; and to this day the 
bulk of army supplies, particularly for a rapidly 
moving force — its backbone or principal staples — 
consists of salt beef, salt pork, bacon or ham, hard- 
tack, flour, rice or corn meal, beans, and butter. 

It was soon found, however, that though a ration 
of salt beef or pork, with wheat, rye, or barley bread, 
and fat, furnished the essentials of a diet and sup- 
plied the necessary fuel units or calories in as com- 
pact, durable, and transportable form as could any- 
where be discovered, it had certain very serious 
draw-backs. 

Of course, it is only fair to remember that these 
articles of food were never intended to form, so to 
speak, more than the backbone of the ration; and 



56 THE DOCTOR IN WAR 

that lighter, less nutritious and more perishable 
things, like fruits and vegetables and sweets, were 
expected to be secured from the enemy's country. 
But with the wanton and reckless methods of waging 
war, setting fire to standing crops, hacking down 
orchards, burning stacks and granaries and barns, 
and pillaging and murdering non-combatants — - 
which until recently we thought we had outlived — 
a country much fought over soon became such a 
desert that armies were compelled to live on the 
rations given them. And the moment they were so 
restricted for more than a few weeks they began to 
go down like sheep — partly with ordinary diseases, 
like typhoid, dysentery, pneumonia, and so on, which 
flourish on a lowered resistance, and partly from a 
perfectly definite and unique disease called scurvy, 
or scorbutus, due entirely to the absence of certain 
elements from the food. 

So serious and so rapid were the ravages of this 
disease that in the Middle Ages it was no unusual 
thing for an army to have one third, one half, or even 
two thirds of its rank and file prostrated by it, and 
from a tenth to a fifth killed. 

For centuries scurvy was supposed to be merely 
one of the innumerable plagues and pestilences that 
sprang up in the track of war; and it was not until 
about two hundred years ago, just before the time 
of Captain Cook's voyages round the world, that we 



FEEDING A MILLION MEN 57 

discovered that this loathsome and deadly disease, 
which loosened the teeth in the jaws, caused the 
joints to swell and become inflamed, and simply 
melted the walls of the blood vessels, letting hemor- 
rhages leak out all over both the inner and outer 
surfaces of the body, was due solely to the absence of 
fruit acids and vegetable alkalies from the diet, and 
could be absolutely cured or prevented by such a 
simple charm as an ounce of lemon juice or half a 
raw potato a day for each man. 

By this time scurvy had become practically con- 
fined to ships' crews, both in the navy and in the 
merchant marine. So lemon juice or lime juice was 
ordered by law to be added to all ships' stores; and 
for several generations afterward the old merchant- 
men that sailed round the Horn were known as "lime- 
juicers," from the fact that they were required to 
carry a regular stock of that life-saving article. 

For fifty years — indeed, practically for a century 
past — the civilized army ration has contained not 
merely bread, meat, and fat, but either fruits or vege- 
tables, and usually both. This modification was, 
however, brought about in a rather curious and in- 
direct way. For many years, and even now in some 
armies, no vegetables, fruit, or sugar appeared in the 
formal list of supplies issued to the troops. 

At first sight it would appear as though these 
were not considered to be needed in the ration. And 



58 THE DOCTOR IN WAR 

anything more uninteresting than the list of so 
many ounces of bread, so many grams of beef, with 
or without bone, so many ounces of lard, grams of 
sugar, and grains of salt, can hardly be imagined. 
It sounds as bleak and unattractive as a prescrip- 
tion. 

When, however, you read between the lines and 
peruse the supplementary regulations, you will dis- 
cover that though, with the rigidity characteristic 
of the military mind, no departure has been per- 
mitted from the sacred and time-honored list of solid 
slabs of food handed down from Mount Sinai, these 
are issued to the soldier in such amounts that he 
cannot possibly eat the whole of his ration, and is 
graciously permitted to sell or exchange the surplus 
for fruits, vegetables, sweets, and such simple luxuries 
as he may crave. 

It is a clumsy old survival of barbarism, redolent 
of the times when barter was the only basis of ex- 
change, money was scarce, and bills of sale were un- 
known ; but it is supposed to put the soldier or mess 
sergeant on his own responsibility, and it saves brain- 
fag in the adjutant general's department. 

It has, however, become largely a matter of form 
or a make-believe game of bookkeeping, for the full 
excessive ration is seldom actually issued. Each 
company or mess is credited with so much money 
expressed in terms of beef, pork, and flour, and it 



FEEDING A MILLION MEN 59 

is permitted to spend the value of whatever surplus 
remains for fruit, fresh vegetables, canned goods, 
sweets, pastry, soft drinks, and so on, either at the 
army stores or in the local shops. 

Indeed, the majority of modern armies stock and 
supply their commissariat departments with a splen- 
did variety of the very best quality of all sorts of 
not merely groceries, fruits, and vegetables, but even 
delicatessen relishes and minor luxuries, which the 
various messes are allowed to select to the amount of 
their surplus bread, beef, and pork, at the ruling 
prices of those staples. 

Another thing discovered by our experience with 
scurvy is that our quick-growing, instinctive dis- 
taste for salted or preserved meats, if served for more 
than one or two meals a week, or for a few days or 
weeks at a stretch, has a sound physiologic basis. 
Though the surest provocative of scurvy is absence 
of fresh fruit or fresh vegetables from the diet, 
there are other forms of anaemia and blood impov- 
erishment, as well as serious nutritional disturbances, 
that are much less likely to occur if the meat in the 
ration is provided fresh instead of salt. 

Practically every modern army now issues its 
meat ration in the form of fresh beef or mutton and, 
where it can, supplements it with fish — though, of 
course, relying to a great degree on bacon or salt beef 
in the exigencies of a campaign. 



60 THE DOCTOR IN WAR 

This has made a great improvement; but there was 
still something lacking. And though it was always 
considered good strategy to encourage soldiers to 
forage as much as possible from the countries through 
which they passed, it was found that, on a diet of 
simple bread, meat, and fat, cravings for variety and 
other foods developed to such a degree as either to 
impair the health of the troops or make them so 
ravenously hungry for all sorts of desserts and trim- 
mings that they devoured eagerly every kind of in- 
digestible and unsuitable green stuff and sweet stuff 
they could get. 

This craving was found to be particularly keen for 
sweets of all sorts; and as soon as the new-found 
luxury, sugar, became cheap enough to be available 
for army supplies, it was tested out with fear and 
trembling, and found to be not merely free from 
danger, but an extremely wholesome, digestible, and 
readily assimilable food; and it was added to the 
army ration. 

Practically all modern army rations now, partic- 
ularly the emergency ration intended for the sup- 
port of bodies of troops in the field, away from their 
supply trains, contain sugar, not merely by the ounce, 
but by the pound. The modern emergency ration, 
for instance, consists of sugar in the form of choco- 
late, bacon, pork, fat, dried albumen, made either 
from white of egg or curds of milk, and a sort of pea- 



FEEDING A MILLION MEN 61 

meal sausage, containing dried peas, beans, or len- 
tils, combined with flavoring herbs — the latter made 
in Germany and of a surpassing nastiness. 

These ingredients are mixed together into a solid 
cake, which may be eaten raw or cooked, or else com- 
bined with water and made into a sort of sweet soup ; 
and sometimes they are used in separate slabs. The 
soldier greatly prefers the latter arrangement, as it 
enables him eagerly to devour the chocolate, fry and 
eat the bacon, and throw away the pea-meal sausage. 

Another substance found very satisfactory as an 
emergency ration is the famous and hallowed pem- 
mican of our boyhood days, when we adore James 
Fenimore Cooper. This consists of meat of some 
sort, either beef, pork, or mutton — it was origi- 
nally, of course, made of venison or buffalo meat — - 
mixed with sugar, raisins, currants, dates, prunes, 
or other dried fruits, packed into canvas or leather 
bags, which are filled and sealed over with melted 
fat. It may be eaten in chunks, with bread or bis- 
cuit, or made into an appetizing and nutritious 
stew. 

The army ration has given the finishing blow to 
our ancient nursery superstition about the unwhole- 
someness of sugar and the way it makes our teeth 
decay, and our livers become enlarged, and our 
joints inflamed with gout and rheumatism, and our 
kidneys "Brightsy." It is one of the best, most 



/ 



62 THE DOCTOR IN WAR 

readily digestible and, at present prices, cheapest 
forms of body fuel we have. Three quarters of the 
work of the body is probably done by burning sugar 
in the cells of our muscles, which later turn it into 
alcohol and explode it in much the .same way that 
gasoline vapor is exploded in the cylinders of an 
automobile — only the cylinders are so innumerable 
and so tiny that we do not hear any chugging and do 
not get the familiar smell. 

This brings the army ration or fuel supply of the 
fighting machine down to practically an irreducible 
minimum of five main type-fuels, lacking any one 
of ^which disease and breakdown are certain — 
bread, beef, fat, sugar, and either fruit juice or vege- 
tables. 

Even such a trifling ingredient as salt is abso- 
lutely indispensable, and its absence is instantly 
felt. On one of its wonderful fast forced marches, 
which established the world's record for infantry, 
a division of Stonewall Jackson's famous "foot 
cavalry'* left its wagons so far behind that it was 
forced to live for three days on nothing but green 
corn, picked and roasted -in the field. When the men 
struck the supply train their first wild rush was for 
the salt barrels, which they stove in at once; and, 
scooping up the salt in handfuls, they licked it up as 
eagerly as colts eat clover in a clover field. 

The next problem was: Can any of these be 



FEEDING A MILLION MEN 63 

exchanged for something either cheaper or better 
adapted for transportation and keeping? Experi- 
ments in this direction have been innumerable; but 
the net result has been to leave the foundation stones 
of army diet pretty much where they were in the 
beginning. 

Beginning with bread, every imaginable grain, 
nut, root, pith, or pulp that contains starch has 
been tried out as a substitute for it, because these 
are either cheaper in proportion to their starch con- 
tent than wheat or can be grown in climates and lati- 
tudes where wheat will not flourish. Corn has been 
tried in the subtropics, rice in the tropics, oats, rye, 
and barley in the north temperate zone, potatoes, 
sago from the palm, and tapioca from the manioc 
root. 

Only the net result can be given here, which is 
that no civilized nation that can raise the money or 
provide the transportation to get wheat will allow 
its army to live on any other yet discovered or in- 
vented grain or starch. Rice, com meal, potatoes, 
sago, and tapioca are, of course, ruled out at once, 
because they contain only starch and nothing to 
match in the slightest degree the twelve or fourteen 
per cent of gluten, or vegetable meat, that gives 
"wheat its supreme value. 

After our first food analyses a desperate attempt 
was made to substitute corn for wheat, because it 



64 THE DOCTOR IN WAR 

contained from five to seven per cent of protein, — 
called zein, — a perfectly good protein in the books 
and in the laboratories ; but it simply would not work 
in the field. Armies fed on it promptly showed signs 
of nitrogen starvation ; and, about thirty years later, 
up came our physiologist with the belated explana- 
tion that, though zein was a right-enough protein 
in composition and chemical structure, only about 
a third of it could be utilized in the human body. 

Even the purely Oriental nations — the Japanese, 
Chinese, and Hindus — born and brought up on 
rice, have formally abandoned it in their army ration 
and have endeavored to substitute wheat for it, 
though expense and the inborn prejudices of their 
soldiers have proved considerable obstacles. Troops 
or nations fed on rice are subject to beri-beri and are 
cured by a diet rich in protein, either vegetable or 
animal, wheat or meat. Meat and wheat in the ra- 
tion have wiped out four fifths of the beri-beri in the 
Japanese army and navy. Those fed on corn be- 
come subject to pellagra, which is ravaging our South- 
ern States to-day. 

As for the northern grains, barley, rye, and oats, 
which also contain some gluten, these are all inferior 
to wheat — rye and barley on account of their low 
protein content and considerable bulk of innutritious, 
gelatinous, and gummy materials, which disturb the 
digestion ; and oats on account of the irritating bitter 



FEEDING A MILLION MEN 65 

extractives with which their high percentage of pro- 
tein is combined. Nobody but a Scotchman can live 
on oatmeal as his sole breadstuff; and it has taken 
generations of training and gallons of whiskey on the 
side to enable even him to do it. 

The successful growth and colonization of the 
white races depend principally on whether wheat 
will grow in the climate in which they try to live. 
The temperate zone is simply the wheat belt and 
the grass-and-beef belt — the only region in the 
world where men can live and grow without suffer- 
ing from nitrogen starvation. "Good as old wheat!" 
is an even higher standard of praise than our farmers 
realize. 

The next foundation stone, for which the econo- 
mists endeavored to substitute something else, just 
as good and far cheaper, was beef; and that noble 
stand-by holds its own like the Rock of Gibraltar. 
No other kinds of meat — venison, fowl, game, fish, 
or other animal substances — would take its place 
for a moment; partly because they are lacking in 
certain elements necessary for nutrition and partly 
because they contain some poisonous flavoring sub- 
stances, extractives or split proteins, which promptly 
upset the digestion and the health when they. are 
used as steady articles of diet. 

Fish, for instance, has less than half the fuel value 
of its own weight in beef, and later researches have 



66 THE DOCTOR IN WAR 

shown that half, even of that fuel value is incapable 
of digestion in the human stomach. Chicken and 
feathered game of all sorts are simply trifles, as well 
as extremely expensive; in fact, the only flesh that 
can for a single month or even week be substituted 
for beef is pork. 

Several years ago I happened to meet in eastern 
Oregon a prosperous and successful man of affairs 
who in his youth had been employed by the Union 
Pacific as a hunter to supply its construction camps, 
when building the railroad across the Great Plains, 
with wild meat — buffalo, venison, antelope, and 
elk. He told me that, at first, the men simply reveled 
in these luxuries; but that after the first week or so, 
if they were compelled to go for a single week or 
even three days in succession without their pork or 
beef, they threatened a mutiny. He summed up his 
experience in one sentence: "I tell you, doctor, 
there's only one meat that's fit for a white man to 
live on, and that's beef, with pork for a second 
choice." 

Any one who has been on an extended hunting or 
exploring trip and run short of bacon will cordially 
indorse this remark. The finest of salmon or trout, 
of venison, partridge, pheasant, or quail, becomes as 
sounding brass or a tinkling cymbal in contrast with 
plain boiled beef or fried bacon. 

A gentleman who had acted as volunteer^ cook for 



ii\c 



FEEDING A MILLION MEN 67 

a hunting party of his friends in the Olympics of the 
North Pacific Coast told me he could fairly cover 
the camp table with clams and broiled salmon, and 
fried venison and roast duck; but, after the first 
ten days out, if clams, salmon, venison, and duck 
were the only things on the board, up would go noses 
and voices at once in the complaint: "What's the 
matter with you? Are you gettin' too lazy to cook 
a little bacon?" 

For campaign purposes, as an indispensable staple, 
bacon is perhaps even more valuable than beef, 
because it is twice as nutritious in proportion to its 
bulk, will keep in any climate, can be cooked any 
old way and yet be good, may be dropped in the 
river, run over by an ammunition wagon, rolled on 
by a mule, left out in the rain all night or in the sun 
all day, and yet be perfectly good chuck — yes, 
"hyas skookum chuck" in the Chinook jargon,' 
"heap bully good grub" — when cleaned, trimmed, 
and fried. 

Besides, it has the great advantage of containing 
the second of the indispensable elements — fat — as 
well ; and it can be used for frying or as shortening in 
bread or biscuit. Blessed be bacon! Like beef, it 
boasts the one great and only unmistakable earmark 
of permanent value — you can eat it once a day all 
the year round and never tire of it. 

As for any of the vegetable substitutes for meat, 



68 THE DOCTOR IN WAR 

such as beans, peas, or lentils, to know them is to 
loathe them. They are rich in protein and very 
cheap; but alas! they contain bitter alkaloids and 
extractives, so intimately blended into their proteins 
that no known methods of steaming or cooking will 
get rid of them. You may bake, you may batter the 
bean as you will, but the taste of the horehound will 
hang round it still. These disagreeable alkaloids are 
not only bitter but poisonous, upsetting the diges- 
tion and impairing the health. This is why neither 
Tommy Atkins nor his American cousin will stand 
for pea-meal sausage in the emergency ration, though 
as vegetables and for variety in the diet, beans and 
peas, both dried and canned are excellent; and the 
famous pork-and-beans can be used as solid nutri- 
ment for two or three meals a week, but not oftener. 
Boston was wise — ■ as usual — when she set the habit 
of eating her sacred beans only on Saturday night 
and Sunday morning. 

But is even this dietetic trinity of bread, beef and 
«ugar, with greens and dessert on the side, sufficient? 
The results of a hundred campaigns have shown that 
it is not. Man is not merely a stomach and muscles 
— he is also a bundle of nerves; and they require 
their share of pabulum. In the early days the nerve- 
steadier in the soldier's diet used to be supplied in 
the form of grog — beer, wine, whiskey; and up to 
about one hundred years ago alcohol in some form 



FEEDING A MILLION MEN 69 

was considered to be an absolutely indispensable 
part of the army ration. 

Gradually, however, and by bitter experience, it 
was realized that alcohol's way of steadying and 
supporting the nerves was to narcotize them, which 
practically means poison them ; that it gave no nour- 
ishment to the body and, instead of improving the 
digestion and utilization of food, really hindered and 
interfered with them. Man must have something to 
drink as well as to eat; but what can be found as a 
substitute? 

About two centuries ago two new planets swam 
into our human ken above the dietetic horizon — 
tea and coffee. They were looked on with great sus- 
picion at first, partly because they were attractive 
and partly because they were new. They were de- 
nounced by the Puritan because they were pleasant, 
and by the doctor because they were not in the phar- 
macopoeia; but, in spite of bitter opposition, they 
won their way. 

It is doubtful whether any addition to the com- 
fort of civilized man within the last two hundred 
years in the realm of dietetics can be mentioned 
that equals them. Certainly, if we take into consid- 
eration the third new article of food, which came in 
and still goes down with them — sugar — it would 
be impossible to match them with anything of equal 
value. 



V 



70 THE DOCTOR IN WAR 

Every army in the world to-day has either tea or 
coffee, or both, as part of its ration. Their advan- 
tages are, briefly: First, they probably provide the 
nerves with a sort of ready-made food — our labora- 
tories have not discovered this fact yet, but they 
will, as they have so many other explanations for 
and justifications of what our instincts knew first. 
Second, tea and coffee add enormously to the at- 
tractiveness of the meal and to our ability to eat 
with relish and appetite large amounts of solid foods. 
No matter how coarse or unattractive the ration, 
providing it has decent fuel value, if it is trimmed 
and washed down with plenty of hot, well-sweetened 
tea or coffee it will fill the bill and keep the mess in 
fighting trim. 

Third, — and this is a very important point, — 
they unconsciously lead the men into the habit of 
taking the greater part of their drinking-water 
boiled. Not only is tea or coffee the main beverage 
at mealtime, but the men get into the habit of filling 
their canteens, before starting on the day's march, 
with cold tea or cold coffee, and thus are saved in 
large measure from the temptation of drinking from 
wells, streams, or ponds, and thus running the risk 
pf typhoid or cholera. 

It was the opinion of both the American and the 
English army medical men who accompanied the 
Russian and Japanese armies in their late war that 



FEEDING A MILLION MEN 71 

the habit of drinking hot or cold tea, almost to the 
exclusion of any other beverage, was largely respon- 
sible for the surprisingly low typhoid rate that ob- 
tained in both armies. 

Last, but by no means least, tea and coffee have 
practically driven beer, wine, whiskey, or any form 
of alcohol out of the field. Our own American ration 
in both army and navy includes no form of alcohol 
at all, but only tea and coffee. Most of the European 
rations still include alcohol, but only for use in spe- 
cial emergencies, such as the chill gray dawn in 
the trenches ; and the change has been greatly to the 
benefit of the soldier physically, mentally, and mor- 
ally. 

As for the injurious effects alleged to be produced 
by tea and coffee, the explanation appears to be that 
they belong to the so-called poison foods, those curi- 
ous substances which, though perfectly wholesome 
and harmless for ninety-nine people out of a hundred, 
are definitely harmful to the hundredth man. Some- 
where from one to three per cent of the community 
are distinctly injured and poisoned by tea or coffee, 
even small amounts producing burning of the stom- 
ach, palpitation of the heart, headache, eruptions 
of the skin, sensations of extreme nervousness, and 
so on, though the remaining ninety-seven per cent 
are not injured by them in any appreciable way if 
consumed in moderation. If tea or coffee poisons 



72 THE DOCTOR IN WAR 

you, let it alone. But for heaven's sake have the grace 
to be ashamed of your infirmity and don't start a 
crusade to prevent normal, healthy people from hav- 
ing it just because it does n't agree with you. Least 
of all try to foist on them some ghastly, sloppy sub- 
stitute like post-mortem serial or other like atrocities. 

Altogether, the army ration closely approximates 
the menu of a well-supplied private home table. Not 
only must there be plenty of the three great staples, 
— bread, meat, and sugar, — but also a good variety 
of fruits, vegetables, puddings, pies, cakes, and other 
trimmings of various descriptions. Since the intro- 
duction of sugar in commercial amounts, and the 
consequent development of methods of canning and 
preserving, the average modern army now takes the 
field with a really splendid variety of canned vege- 
tables, canned fruits, oysters, canned meats, — par- 
ticularly in the form of canned corned-beef hash, — 
preserves of all descriptions, and dried fruits, also 
chocolate and pure candy by the ton; and sets for 
its men a table that is in no respect inferior, either in 
nutrition or attractiveness, to that of the average 
three-dollar-a-day hotel. 

This change is not limited or confined to any one 
nation or group of nations. All over the world, where- 
ever men feed and fight, their commissariat depart- 
ment endeavors to supply them with substantially 
the same diet and trimmings. The amusing super- 



FEEDING A MILLION MEN 73 

stition, for instance, eagerly spread about by our 
vegetarian friends, that the Japanese army in its 
campaign against Russia fought on a diet of rice, 
vegetables, and salt fish, was exploded long ago. 
For thirteen years before that war, and in deliber- 
ate preparation for it, the Japanese army and navy 
had been living on a ration containing beef, wheat 
flour, sugar, pork, butter, and apples, modeled as 
nearly as circumstances and convenience would per- 
mit on that of the English, French, and American 
armies. 

Itsis true that, during the stress of the campaign, 
the supply of beef fell off somewhat, and that the 
newly levied troops objected to eating wheat bread 
in place of rice; but in the main their victorious cam- 
paign was fought on as near an approximation as 
was practical to the European army ration. 

The same curious inflexibility of the ration has 
been found in campaigns in tropical climates. When 
we first began seriously to consider and scientifically 
to study our foods, it was customary to assume that 
tropical races, having lived for generations in tropi- 
cal climates, had gradually hit on the ideal diet 
adapted to those conditions. So, when our Northern 
soldiers were sent into Africa, India, Asia, and the 
Philippines, an attempt was made to get them to live 
on the diet of rice, fish, and vegetables on which the 
natives maintained an existence. 






74 THE DOCTOR IN WAR 

It was supposed that a hot climate, not calling for 
so much heat production on the part of the body, 
made a lighter and less nutritious diet advisable. 
And the frightful mortality which often affected 
Northern European troops in tropical stations was 
sometimes attributed . to their insisting on eating 
large amounts of meat, fat, and other "heating" 
foods, which they had been accustomed to eat in 
their home climate. 

Two facts, however, have stood out from the very 
beginning of careful study of this matter: First, that 
at least ninety per cent of the disease and mortality, 
particularly of the intestines and liver, which had 
been so constantly attributed to ill-chosen food, was 
due to infectious disease; and that the moment the 
germs of disease were excluded the mortality and 
high sickness-rate almost disappeared. Screening 
the windows, draining the ponds, and filtering the 
drinking water, for instance, cut down at once four 
fifths of the tropical diseases, malaria, typhoid, chol- 
era, dysentery, etc., to which our Northern troops fell 
victims. Food had absolutely nothing to do with it, 
except in so far as it was a means of carrying in- 
fection. * 

, The second thing was that, though the natives of 
the tropics could get along fairly well at their own 
level of living and rate of expenditure of energy on 
their tropical diet, the moment they were put to any 



FEEDING A MILLION MEN 



75 



task that called for strenuous and continued exer- 
tion they broke down at once. If, however, before 
they were called on to do white men's work, whether 
as native troops or as laborers on railroads, canals, 
and so on, they were put for a couple of weeks on a 
full white man's ration, the breakdown did not take 
place. 

It has now been shown in every climate in the 
world — most strikingly in the building of our Pan- 
ama Canal — that native laborers, placed on the full 
Northern army ration, plenty of beef, pork, sugar, 
and wheat bread, would increase their working 
power twenty-five, thirty-five, or fifty per cent 
within six months; and at the same time, instead of 
developing stomach and liver disease from over- 
eating, they would become healthier and stronger 
and less subject even to the tropical infections among 
which they live. 

In other words, tropical races live on a diet of rice 
and' vegetables for one reason, and only one, and 
that is poverty — which, by the way, is the only real 
cause for any of the spare and exclusive diets of 
mankind in any part of the world. The minute the 
most famous vegetarian races can get their hands 
on meat and fat, they devour them eagerly and im- 
prove enormously in both working power and health. 

The tropical ration for European or American 
armies now consists of practically the same staples 



76 THE DOCTOR IN WAR 

that are used in the North, with a little less meat on 
account of its power of raising the body temperature, 
a little less fat, and somewhat larger amounts of 
sugar, fruits, and vegetables. If the army is to take 
the field and make forced marches, climb mountains, 
wade rivers, and lie out in the open, it requires just 
as full and abundant a ration of meat, fat, and wheat 
bread as it does during a Northern campaign in a 
temperate climate. 

A large share of the alleged indolence, fatalism, 
and lack of energy in the peoples of the tropics is 
due to the fact that they are underfed, and partic- 
ularly starved of protein, and the balance to malaria 
and hookworm. Plenty of meat or other protein, 
mosquito nets, spades, and drain tiles will enable the 
white race to colonize any part of the tropics, pro- 
vided some mountain resort can be brought within 
striking distance by rail, where the women and chil- 
dren may be sent during the heated season and the 
men may spend two months or more out of each 
year, assisted by proper travel and vacations in tem- 
perate climates. 

Not only does the most scientific, up-to-date army 
ration match, as to its composition, the kind that 
mother used to cook, but it is approaching it as rap- 
idly as possible in methods of cooking and serving. 
In an early day each soldier carried not only his food- 
supply but also his cooking utensils on his back or 



FEEDING A MILLION MEN 77 

at his saddlebow, squatted down in the dirt, and lit- 
erally "messed" for himself. 

Echoes of that Golden Age still linger; and even 
in textbooks on military hygiene you will find re- 
gretful allusions to the days when the Scotch Bor- 
derer rode down from the Grampians on his shaggy 
pony, with a bag of oatmeal, a little salt, and a 
sheet-iron griddle-plate hanging at his saddle for his 
entire commissariat department; or to the famous 
Arab cavalry, which would start on a three weeks' 
campaign with a bag of parched barley on one side 
of the saddle and one of dried dates on the other. 

These gentle adventurers expected to steal most of 
their food ; but, though they could make a campaign 
after a sort on such chicken feed, they could not 
have stood up before a modern bayonet charge for 
two minutes on any such trash. If they happened 
to be kept in the field for more than three or four 
weeks three quarters of them never went home, but 
died of typhoid, cholera, dysentery, and other filth 
diseases. 

The modern soldier, of course, still carries his 
mess-tin, pannikin, knife, fork, and spoon; and the 
things he cannot cook and eat with this excellent 
rough-and-ready outfit would make a very short list 
indeed. The mess-tin is a particularly admirable 
utensil of oval shape, about the size and depth of an 
ordinary pie tin, made of the thickest block tin, 



78 THE DOCTOR IN WAR 

which means, of course, sheet iron thickly plated 
with tin. It has a lid or cover and also a handle, 
hinged to it, which can be folded over it when it is 
closed. Put on the cover and you have a good small 
Dutch oven or baking-dish, which can be buried in 
the coals; straighten out the handle and you have 
an excellent frying-pan, in which both biscuits and 
bread can also be cooked. 

The pannikin, or cup, is made in one piece, also 
of the heaviest block tin, holds more than a pint, 
has a folding handle and will boil anything that can 
be boiled, from coffee and tea to beans and onions — • 
except, of course, rice as tackled by the raw recruit. 
A classic story is told of a green soldier who, finding 
a pound of rice in his ration, proceeded to cook it for 
supper. He poured it all into his quart cup, covered 
it with water, and put it on to boil. When it started 
to swell it began to erupt gently and flow over the 
side of the cup into the fire. In alarm he spooned out 
the top layer into his tin plate; but the can was full 
again before he could turn around. Next he ladled 
his frying-pan full, and then filled his tin cup. Then 
he filled the pie tin and the water dipper, until 
finally every utensil in camp was full to the brim. 
Still the rolling flood of rice pudding rose and swelled 
and majestically overflowed. 

Inside the mess tin are three canvas bags for salt, 
sugar, and coffee; and in the haversack there is a 



FEEDING A MILLION MEN 



79 



ration of bacon, bread, and beans. This outfit is in- 
tended only to make the soldier self-supporting for 
a few days, or a week at the outside, when he leaves 
his baggage wagons behind or is separated from them. 
The plan now is to cater and cook for an army in 
the field almost as carefully and in as appetizing a 
manner as in garrison or at home. Instead of divid- 
ing the men — on the ancient and venerable method 
that was one of Sparta's contributions to the art of 
war — into messes of eight or ten, one of whom would 
volunteer or be commandeered as cook, — - which 
was probably the origin of the classic epigram, "God 
sends meat, and the Devil sends cooks!" — the unit 
of the cook supply is either the company, as in the 
United States Army, or the battalion, as in most 
European armies. 

The army cook is a well-paid, trained expert, who 
has either learned his profession in private life or been 
sent to one of the old schools of cookery maintained 
by the army. The United States Army, for instance, 
had three of these — one in the East, one in the 
South, and one in the West. He has for his company 
— ranging from sixty men in time of peace to one 
hundred or one hundred and ten on a war footing — - 
a staff of from one to three assistants, two cook's 
police, and a helper or two. 

In the early days a cook had to be an inventor as 
well as a mechanic; and stories are still told of famous 



80 THE DOCTOR IN WAR 

army cooks who could make bread, ready to eat 
within twenty-five minutes, out of flour in the barrel, 
without pans, cooking utensils, range, or stove. Their 
method was to knock in the head of the barrel; 
scoop a hole in the top of the flour, pour into this 
hole water, with salt and, if available, baking powder 
or yeast; mix up the dough in this flour-lined knead- 
ing pan and pat it into flat cakes, knock one or two 
barrels apart, sharpen the staves at both ends, cut 
them in two, stand the dough cakes before a roaring 
fire on these shingles, and, when done on one side, 
turn over and roast on the other. 

To-day, however, the army cook takes the field 
with a portable sheet-iron stove, into which, tele- 
scoping into one another, fits a full equipment of 
pans, kettles, boilers, and dishes of all sorts. This 
stove is quickly set up ; the pans, as emptied out, are 
passed round to his helpers; and within thirty min- 
utes he has a full outdoor kitchen improvised, that 
needs only an awning stretched over it to make a 
regular cookhouse. 

Most of the present armies, notably the English, 
go farther than this, and have regular portable kitch- 
ens or cooking-stoves mounted on wheels and drawn 
by one or two horses, or driven by motors, which 
accompany each battalion in the field. These kitch- 
ens are provided not merely with a fire-box and 
cooking-utensils, but also water-tanks and caldrons 



FEEDING A MILLION MEN 



81 



with waterproof lids, which can be screwed down so 
that a meal can be started before breaking camp and 
continue cooking while on the march. The moment 
the army stops, all that is necessary is to take off the 
lids and serve the soldiers a hot, steaming meal. 

These portable kitchens also have the great ad- 
vantage of keeping the army, while on the march, 
constantly supplied with hot water from which tea, 
coffee, soups or broths may be made. 

The United States Army now provides a capital 
special manual for army cooks, which gives careful 
directions for the most appetizing and attractive 
methods of cooking the different elements of the 
ration and the best ways of serving; insists on the 
most scrupulous care in keeping dishes and utensils 
of every sort spotlessly clean and sweet, and so on. 
Complete and most appetizing recipes are included 
for mincemeat, lemon pie, ice-cream, pineapple ice, 
corn fritters, layer cake, crullers, potato salad, clam 
chowder, crab-meat stew, and other things that 
fairly make the mouth water. 

The elaborateness of providing and serving the 
army ration is not a sign of the growth of luxury or 
effeminacy — • it is a matter of the highest economy 
and best possible strategy, as well as of investment; 
because men will march better, fight better, drink 
and dissipate far less on an abundant, varied, well- 
cooked, hot, and attractively served diet than they 



82 THE DOCTOR IN WAR 

will on bacon and hard-tack cooked in the ashes — 
which means in the dirt — and served on sticks or 
slabs of bark. 

Everybody who has had experience in camping 
knows that camp cookery and men-folks' amateur 
cookery generally are simply a dirty and rather dis- 
agreeable form of mitigated starvation. It is all very 
well to live on camp diet when you are simply loaf- 
ing and amusing yourself; but when you try to work 
on it it soon blows up — or, rather, you do. Lumber 
camps, railroad gangs, and engineering camps of 
every sort and description now give as rich, liberal, 
varied, and well-cooked a diet as can be found any- 
where in civilization — not out of philanthropy, 
but because it pays. 

One of these days a nation or a community at 
peace will study its food-supply, arrange for its 
proper production in the most appropriate soils and 
climates; its shipment with the greatest economy of 
movement and least possible expense; its handling 
and storage with the highest degree of cleanliness and 
economy; and its distribution to the consumer in 
good condition and at a low price — in the same way 
that an army commissariat department now sup- 
plies its troops. When it does this we shall see an 
increase in national efficiency, in working power, in 
health, and in happiness of at least thirty-five per 
cent within thirty years. 



IV 

THE SUPERB HEALTH OF THE ARMIES 

I HAD the good fortune to be in Paris on the 14th 
of July, France's National Day, which she keeps 
as religiously as we do our beloved Fourth. It was 
celebrated this year (19 17), by a great review of 
troops at the Cour de Vincennes, not sham-battle 
soldiers, but real ones — veterans of nearly three years 
of fierce, incessant campaigning. 

New colors were presented by the President of the 
Republic to some sixty regiments that had distin- 
guished themselves on the Field of Honor. Each 
regiment sent up a company to receive its trophies 
and serve as a guard of honor, and then to march 
proudly through the crowded and cheering streets of 
Paris, bearing their new colors, making a total of 
over eight thousand men in line. It was one of the 
most magnificent and cheering spectacles I have ever 
seen — not merely from a patriotic and fraternal 
point of view, but also from a physical and scientific 
one. 

It would be impossible to imagine a more continu- 
ous and unbroken stream of splendid health and 
physical vigor and endurance than these war-worn 
veterans presented. After the storms of blood and 



84 THE DOCTOR IN WAR 

fire and shell rain and poison gas which'they had been 
through; after the magnificent fight that they had 
kept up for almost three years, in the beginning 
against overwhelming odds, one might well have 
expected to see faces lined and worn, eyes sunk and 
grave, though bravely resolute, shoulders a little 
bowed by the burden of the years of war. But here 
they came — these heroes of a hundred bloody at- 
tacks and counter-attacks, these veterans of Ver- 
dun, of the Marne, of the Somme, with the bright 
eyes, the fresh color, the cheerful smile, the free elas- 
tic gait, of a band of college students celebrating a 
football triumph. The eyes were steadier, the jaws a 
little squarer, the whole set of the face and carriage 
more purposeful and dignified, but for sheer splen- 
did joy of living and fearless sense of readiness and 
fitness for anything, they could not have been sur- 
passed by any intercollegiate team of athletes. They 
had seen the horrors of war, they had looked death 
in the face a thousand times, but it had neither sad- 
dened nor depressed them. 

I looked about, right and left, at the faces that 
lined the street on either side and behind me — 
faces for the most part of sturdy, vigorous, laboring 
people, who had come in from the outer suburbs and 
surrounding country for the great event. I passed in 
review, before my mind's eye, the crowds who would 
throng the streets at home on a like celebration. 



THE HEALTH OF THE ARMIES 85 

And it would have been utterly impossible to have 
picked out, from even the most vigorous and hard- 
working of peaceful spectators, any such body of 
joyous, clean-drawn athletes as were marching in 
horizon-blue uniform and steel helmets, with shining, 
fixed bayonets down the street. 

The day was close and sultry, the streets jammed 
and packed with a perspiring crowd. The place 
where I stood was a good two miles and a half from 
the review ground, and the men were marching in 
full field uniform, with long, heavy overcoats, great 
steel helmets on their heads, with rifles, fixed bayo- 
nets, and ammunition belts. Yet they fairly danced 
along, as if they were enjoying it, every foot of it. 
It was one of the most magnificent and cheering 
demonstrations of the everlasting resiliency, the 
utter irrepressibleness of the human physique and of 
the human spirit. 

If any one imagines, as would not be unnatural, 
that three continuous years of the hell of week-long 
bombardments and of the bitter and unheard-of 
hardships of the trenches must have worn the nerves 
and wearied the spirits of the long-suffering army, 
one good look at the ruddy, cheerful faces, the broad, 
square shoulders, straight backs, and lithe, elastic 
limbs of those joyously marching columns would be a 
convincing revelation to the contrary. 

Incidentally, on the other hand, though this is not 



86 , THE DOCTOR IN WAR 

perhaps sticking strictly to the professional last, it 
did one good to see how the temper and spirit of the 
crowd met and matched that of the fighting men. 
Everywhere shone the same high courage, the same 
proud endurance, the same confidence of ultimate 
victory. Though the brave, sad eyes of the women 
haunted one at every turn, and a plain black band on 
many a coat-sleeve told of bitter bereavement, yet 
the memories of their sacrifices simply strengthened 
and deepened their pride and joy in the splendid 
army which they had put in the field and were sup- 
porting there, and hardened their determination to 
continue the slowly but surely winning fight to final 
triumph. 

Nor is this cheering condition confined to the crack 
or picked regiments. I have seen hundreds of regi- 
ments, thousands of platoons, in their camps, on the 
exercise grounds, marching along the roads, going up 
to or coming back from the trenches at the front, 
changing lines from one army to another, entraining 
and detraining at the great railroad stations, and 
never have I seen anywhere, in forty years' careful 
and affectionate observation of the genus humanum 
in time of peace, such a vigorous, free-moving, clear- 
eyed, fresh-colored set of athletes in the literal "pink 
of condition"! 

The thing is so universal that it is overwhelming — 
from Sheffield to Soissons, from Melbourne to Mes- 



THE HEALTH OF THE ARMIES 87 

sines, the shock of sheer pleasure, to the eye of the 
physical trainer, from the swinging ranks of every 
regiment that one sees on the march. One gets actu- 
ally to look out for the exceptions, to think of each 
rippling line of horizon-blue or khaki that one meets 
streaming down one side of the crowded road, while 
the flood of artillery and transport pours past along 
the other, "This one is going to be the exception — 
here come the misfits, that have been kept in the 
background — these men will show the combings of 
conscription or the hardships of the trenches, the 
nerve-strain of the thundering bombardments.' ' 
But each time you are agreeably disappointed. 

Ruddy, sweating, and leaning well into their pack- 
straps, caked with mud or powdered with dust, still 
they were covering the ground easily, and in work- 
manlike fashion, from the hips, heads up, eyes bright, 
foreheads unwrinkled. Cheerful, smiling, often sing- 
ing, or guying one another, or playing practical jokes 
as they tramped along, rippling from head to heel 
with the sheer joy of physical fitness and vigor, the 
glory of the flesh — they looked as if they had not a 
care in the world, and were ready for anything, like 
Landor's heroes of old Greece, "Who with a frolic 
welcome met the thunder and the sunshine." 

The armies in France to-day (191 7), including our 
splendidly conditioned, lean, wiry, and sunburnt 
boys from the Mexican border, are a triumph of 



88 THE DOCTOR IN WAR 

what can be accomplished by intelligent, united 
physical training, splendid feeding, and the most 
watchful and expert of sanitary care. So superbly 
has the combination worked that the men in the 
camps and in the trenches have actually, outside, of 
course, of battle casualties and wounds, a lower dis- 
ease-rate and a far lower death-rate from disease 
than the armies of the respective countries have in 
their barracks in time of peace, and of course far 
below that of the average civil population. Even 
through the awful weather of last winter — the worst 
in twenty years, not merely coldest, but stormiest — 
when flooding rain and driving sleet and bitter frost 
and whirling snow alternated with one another 
against a background of bottomless, stinking mud 
right up to the middle of April, I found actually less 
influenza and sore throat, pneumonia and bronchitis, 
in the trenches than there were in Paris or London or 
New York. 

Still more unexpected and incredible, all through 
one of the savagest and severest winter campaigns 
ever fought, under an unprecedented strain of con- 
tinuous exposure to the elements in their most bit- 
ter and vicious forms, one of the longest and most 
grueling endurance runs to which the human auto- 
mobile has ever been submitted, there was less 
rheumatism than in a great city hospital during the 
same months. In fact, the disease was astonish- 



THE HEALTH OF THE ARMIES 89 

ingly rare and most of it of the so-called muscular 
variety. 

How has this splendid and lasting physical perfec- 
tion of the fighting man, this capacity to rise superior 
to all the strange and unexpected stresses and hard- 
ships of modern war, been brought about? Simply 
by that infinite capacity for taking pains which Buf- 
fon declared was genius. From the day that the new 
recruit first joined the colors, every detail of his 
clothing, his equipment, his feeding, his housing, his 
physical training, his protection against disease, has 
been taken over and watched with sleepless care, 
according to most carefully thought-out and tested 
plans. 

A staff — literally an army in itself — of the ablest 
and most carefully selected experts in sanitation, in 
food-supply, in engineering, in physical training, and 
in medicine, has been brought together for this from 
all the resources of civilization. His food, the famous 
army ration, represents the experience of years and 
the labors of commission after commission, not merely 
of practiced campaigners, but of physiologists, food 
experts, chemists. Its amount, its constituents, its 
proportions, and its variety have been determined 
almost regardless of considerations of expense, sim- 
ply for the purpose of supplying the human machine 
with the most abundant and effective and strength- 
supporting supply of fuel possible which is available 



90 THE DOCTOR IN WAR 

in sufficient amounts in the field and reasonably 
capable of transportation. 

No college athletes' training-table serves any- 
thing better from the point of view of actual need for 
vigor, efficiency, and endurance than the modern 
army ration, particularly our own and that of Eng- 
land. Its only weakness, which, of course, is inher- 
ent in all army rations, is in point of variety and 
elasticity, so to speak, particularly in the more per- 
ishable accessory foods such as fresh vegetables, 
fresh fruits, eggs, milk, etc. But these in this war 
have been very largely made good by canteens, 
Y.M.C.A. "huts," with their cafes, and the judi- 
cious patronage and encouragement of "local indus- 
tries." There is scarcely another diet in the land, 
even in the most luxurious and expensive private 
tables which is chosen so solely with an eye to vigor 
and health and with so little regard to expense in the 
essentials. 

Every detail of the fighting man's clothing, the cut 
and texture of his uniform, his underwear, the qual- 
ity of his socks, the shape of his shoes, is the product 
of generations of patient and unwearied study and 
experiment. Just to take one detail: The new army 
shoe of the United States Army is one of the most 
perfect and practical specimens of human footwear 
anywhere to be found, and the report of the commis- 
sion of army surgeons headed by Major Munson, 



THE HEALTH OF THE ARMIES 91 

which recommended it, is one of the ablest and most 
authoritative documents, in literature, upon shoes 
and their structure and the care and protection of 
the feet. 

The site for his training camp is selected with the 
greatest care, usually upon rolling, porous ground 
with good natural drainage and exposure; it is care- 
fully drained both surface and deep, supplied with 
perfect water and a system of sewers; in fact, many 
of the more favorably situated sites might be easily 
described without any exaggeration as military 
health resorts. He is housed — not merely in the 
training camp, but usually also in the field, on ac- 
count of one of the redeeming features of trench 
warfare, its comparative stationariness — in com- 
fortable wooden barracks called huts, planned for 
protection and warmth combined with ventilation. 
His washing is taken care of, either by the hard- 
working and competent women of the neighboring 
country, or in the camps and in most places on the 
front by great steam laundries capable of handling 
thousands of garments per hour which are installed 
at some convenient point toward the base, for each 
army. 

He has not only the best and promptest of medical 
attention, but splendid hospital care if he falls sick. 
Every possible precaution, however, is taken to pre- 
vent the possibility of the development of disease or 



92 THE DOCTOR IN WAR 

exposure to infection. Each large army area has not 
merely its regimental doctors and hospital surgeons 
and physicians, but a visiting sanitary inspector, 
with a staff of sanitary-service men in each camp 
who devote their entire time to inspecting and keep- 
ing up to the mark all the sanitary arrangements of 
the camps. 

In most camps every particle of refuse, of night 
soil, of garbage that cannot be utilized, is not only 
collected with the most scrupulous care and cleanli- 
ness, but completely destroyed by burning, which 
ends at once all possibility of its ever getting into the 
water-supply, or fouling new camp sites, or reappear- 
ing in any possible way to cause trouble in the future. 
All the manure from the cavalry and transport lines 
is either spread upon the land at once, often by the 
thrifty farmers of the neighborhood, or else burnt. 
This burning process calls for a good deal of trouble 
and skill, but it has another tremendous advantage 
in camp hygiene, that it robs our most intimate 
enemy and pest, the fly, of most of his hope of exist- 
ence, by depriving him of both pasturage and breed- 
ing-grounds. This is supplemented by a vigorous 
anti-fly campaign, with the result that a large pro- 
portion of our camps on the Western Front are com- 
paratively free from the plague of flies, which means 
that two thirds of the risks of diarrhoea and dysen- 
tery are wiped out at one stroke, and accounts for a 



THE HEALTH OF THE ARMIES 93 

really astonishing scarcity on the Western Front of 
both these typical army diseases. And the head of 
the list in this triumph of sanitation and cleanliness 
is held by the Italian army camp and hospitals. 

The wonderful protection against typhoid secured 
by vaccination is now a household word. The high 
feeding and good housing and ventilation, with the 
open-air life, give almost sanatorium conditions 
against tuberculosis as well as against pneumonia 
and bronchitis. 

In fine, I have no hesitation in asserting, on the 
basis of a fairly extensive sanitary experience on both 
sides of the Atlantic, that I know very few cities in 
the world, even those that pride themselves on the 
perfection of their health departments, which are 
kept in as good sanitary condition, with as little dis- 
ease, as are the majority of our camps on the Western 
Front. So that the father and mother who give their 
boy for the defense of his country may have at least 
the consolation and satisfaction of knowing that the 
only risks that he will run are the necessary and insep- 
arable perils of the battle-field itself. It is hardly too 
much to say that nowhere in the world to-day are 
bodies of young men maintained under better and 
wholesomer hygienic — yes, and moral and intellec- 
tual — surroundings and influences than the soldiers 
on the battle-fronts of Western Europe. Those who 
survive the sad and inseparable crowning risks of 



94 THE DOCTOR IN WAR 

battle, death, or permanent disability, which will not 
exceed all told three per cent per annum, will have 
had a training and improving of their physique, a 
quickening and broadening of their intellect, which 
will be an endowment and valuable education for 
any field of future work and a permanent benefit to 
them through after life. 



V 

THE LAND OF THE HAPPY WARRIOR AND 
THE CHEERFUL WOUNDED 

HE jests at scars who rests on a CCS. pillow. 
Of course everybody knows what a "CCS." 
is — or if they don't, they ought to, because it is 
about the biggest thing that has happened since the 
beginning of this war in the way of humanity and 
helpful science. "CCS.," in chilly, laconic, official 
speech, means "Casualty Clearing-Station." But to 
hundreds of thousands of our brave wounded, it 
means far more than that. To them the three magic 
letters stand for a little hospital heaven here upon 
earth, ease after agony, rest after torment, cleanness 
and coolness and comfort, after mud and filth and 
carnage, Elysium after Tophet. 

A Casualty Clearing-Station is a little first-class 
city hospitat on the pavilion plan, all complete with 
every modern convenience: full staff of surgeons, 
nurses, orderlies, X-Ray Room, Bacteriological Lab- 
oratory, hot and cold water, electric light — dropped 
down on the field of war within five or ten miles of 
the firing-line. Not so very little either, for some 
of them have over a thousand beds, though the 
average is about three or four hundred. The main 



96 THE DOCTOR IN WAR 

difference between it and a city hospital is that it 
is built of wood instead of brick or stone and that 
it lies alongside of a railway line. Its wards consist 
of long, plain but comfortable wooden buildings, 
some sixty feet long by twenty-odd wide, with win- 
dows every ten feet and a ventilator in the roof, called 
by the absurd and inadequate name of "huts." They 
have good wooden floors, tarred, weather- tight roofs, 
windows, with a "hopper" upper sash for oblique 
ventilation, and stoves so that they can be kept warm 
and dry as toast in cold or stormy weather. 

Their only administrative drawback is that nurses 
and patients have to go out of doors each time they 
pass from one ward to another or from the ward to the 
operating-room. But this is now being overcome by 
grouping them together by fours in the shape of the 
letter "H," with the operating- and dressing-rooms 
as the cross-bar and connected by roofed passage- 
ways. 

So comfortable and efficient are these stations and 
so well do they serve their purpose that they raise 
the question, in the minds of all who have served in 
them, whether it is really necessary in our great city 
hospitals to spend the enormous sums, rising some- 
times to as much as five thousand dollars per bed, on 
huge and majestic monuments of stone and steel and 
glass, when all the fundamental essentials for the 
care of the sick and the wounded, in plain, vernac- 




A WOUNDED MAN CHEERED BY A CHAPLAIN AS HE IS BROUGHT 
IN ON THE LIGHT RAILWAY, WESTERN FRONT 




WOUNDED ON THE LIGHT RAILWAY, SALONICA FRONT 



THE HAPPY WARRIOR 97 

ular phrase, the "guts" of a hospital, are provided 
here in wood and tar paper for about one hundred 
dollars per bed? A question which our experience with 
sanatoria for tuberculosis has also suggested to us. 

Modern war is no longer solely destructive; nearly 
half its energies are devoted to clothing and feeding 
and healing, and the central and vital knot of its 
work of healing, repairing, and making over again the 
wreckage from the firing-line is the Casualty Clearing- 
Station. 

Into its front gate pour, converging like the sticks 
of a fan, the lines of ambulances bearing the wounded 
from a five- to fifteen-mile sector of the Front. From 
its back door, which opens directly upon a line or 
spur of railway, its clean and convalescing "gradu- 
ates," when pronounced fit to travel, are " cleared " 
directly into the comfortable berths of the long 
hospital trains, which roll them down to, and dis- 
tribute them among, the great base hospitals near 
the coast, or to the quays alongside the waiting 
hospital ships for " Blighty " direct. 

From the moment that a man falls and is picked up 
by the stretcher-bearers, the superb scheme of the 
Royal Army Medical Service takes complete and com- 
petent charge of him. All he has to do is to press the 
button by getting wounded and it does the rest, and 
does it astoundingly, incredibly well. Our American 
Medical Service in France is planned and carried out 



98 THE DOCTOR IN WAR 

along almost exactly the same lines, though as one 
after another of our army surgeons who has seen the 
superb British system at work has exclaimed to me : 
"If we can only build up anything like it in five 
years!" 

The first stage of his journey toward recovery — 
for of every hundred men not killed outright or 
dying before the bearers can bring them in, ninety 
recover — ends at the Regimental Aid Station, or 
"Poste de Secours" as the French call it, in the 
third-line trench or close behind it. Usually he is 
carried by bearers all the way to this, but in par- 
ticularly well-planned trenches, where the nature of 
the ground and the slant of the enemy's fire per- 
mit, he goes on wheels along extra wide communicat- 
ing trenches, paved so as to allow ammunition to be 
wheeled out in handcarts and to bring wounded 
back, or even laid with small trolley lines and hand- 
cars for this double service. This is a great mercy, for 
though the stretcher-bearers are gentleness itself, 
there is an inevitable swing and joggle about this 
method of carriage which is agony for the grating 
ends of a broken bone. 

If the wounded man is so badly hurt or bleeding so 
profusely as to make it risky to lift him, a tourniquet 
is put on if possible, and a runner sent back for the 
surgeon. This does n't take long, for, although ac- 
cording to the Regulations, a surgeon's place is in the 



THE HAPPY WARRIOR 99 

third-line trench, for good and obvious reasons, 
when the wounded are coming in quickly, so that 
they know just where to find him and where he has 
his table and orderlies and ether and instruments, 
etc., he is often found, in the beginning of an at- 
tack, well up in the second or even the front-line 
trenches; where he has no official business whatever, 
only it gives the men confidence and they like to 
feel that he is close at hand and in easy reach, in 
case of — accidents. 

In an earlier day the surgeon often actually "went 
over the top " with the rest of the line in a charge, 
but the men themselves affectionately protested 
against this. Supposing something happened to the 
doctor — a dozen men might bleed to death before 
another surgeon could be brought up from the 
Dressing-Stations in the rear; and it is no longer 
considered good form. 

In hundreds of instances, however, when "No 
Man's Land " begins to get populated by groaning 
and writhing figures, over has gone the surgeon, in- 
struments, ether, bandages, and all, and establishing 
a Dressing-Station at the bottom of a shell-crater, 
where the wounded at least are fairly safe from every- 
thing but a direct hit of shell, has gone about his 
healing business under a perfect hell of fire, as calmly 
as if he were in his white enameled sky-lighted operat- 
ing-room at home. 



ioo THE DOCTOR IN WAR 

I saw the ribbon of one Victoria Cross on the coat 
of a quiet young surgeon, who after a charge had 
walked out with his instruments into the middle of 
the Zone of Death, and, dropping on his knees be- 
side the first wounded man, had calmly worked his 
way down the whole length of the regimental front with- 
out a shred of cover or protection, taking every case 
as he went, both friend and foe, until the field was 
cleared of wounded. 

There are, however, practical drawbacks to the 
shell-hole dressing-station, in addition to its extreme 
immediate riskiness. On account of the — to put it 
mildly — indiscriminateness of the Hun fire, you are 
extremely likely to have half the wounded you have 
so carefully operated on and patched up torn to bits 
by a shell or wounded afresh by rifle or machine-gun 
bullets, while they are being carried to the shelter of 
the front trench. On the whole, Tommy's judgment 
is sound. " Better risk a few stretcher-bearers, fetch- 
ing 'em in, or if the strafing is too fierce, wait till dark." 

But the post of Regimental Surgeon is something 
of a man's job and the real place of honor in this War 
of Life-Saving. That it is filled by real men in hun- 
dreds may be grimly glimpsed from the report that 
over four hundred surgeons were killed or wounded 
on the Somme alone in 191 6. 

The Regimental Aid Post where our wounded 
man first halts — we ought to have a good single- 



• 


^4» /• 




Ej( i^^^i i 




S&\ ^H kJ@98 


(■BR" ,,—,-. JttEr^L 
B5F^ -ty^T? ■ 







DRESSING A GUARDS OFFICER ON A FLANDERS BATTLE-FIELD 




CANADIAN RED CROSS MEN ATTENDING TO WOUNDED GERMANS 
AT AN ADVANCE DRESSING-STATION 



THE HAPPY WARRIOR 101 

word name for him, like the French, who say simply 
"un blesse," "a wounded,' ' plural " blesses," as a 
dear old French surgeon-general used to translate it 
for me "our poor woundeds" — is usually in a dug- 
out, or in a vaulted hut made of heavy iron arches, 
set side by side and covered with earth and turf, 
known as "an elephant"; because nothing delights 
the Boche so much as nosing out one of these aid 
posts full of wounded and shelling it. 

Here the surgeon, with his table and orderlies, cuts 
open the clothing and makes a rapid but careful ex- 
amination of the wounds, ties up any spouting or 
badly oozing arteries, puts temporary splints upon 
any broken limbs, and dresses and binds up the 
wounds, for the trip to the Casualty Clearing-Sta- 
tion. If the wound is at all serious he gives a "shot " 
of tetanus anti-toxin, to ward off lockjaw, and if the 
pain is severe an injection of morphine. In the be- 
ginning of the war there was an alarming amount of 
tetanus, or lockjaw, with many deaths, among the 
wounded; due chiefly to the curious fact that the 
battles were being fought upon some of the richest 
and most intensively cultivated land in Europe. The 
soil, having been very heavily fertilized with stable 
manure, was simply swarming with tetanus bacilli, 
whose natural habitat is the intestinal canal of the 
horse, and these were blown deep into the wounds 
on fragments of shell. Thanks to the tetanus anti- 



102 THE DOCTOR IN WAR 

toxin, however, this deadly disease was quickly 
brought down to the vanishing point and has been 
kept there ever since, but only by dint of constant 
vigilance and by free use of the preventive dose. The 
only drawback to its use is that it consists of the 
serum of the blood of immunized horses, and this 
"foreign serum " sensitizes the blood in a curious way. 
So that if a man gets wounded a second time — and 
thousands of them do — and a second dose of the 
anti-toxin is given, he may break out into a furious 
itching eruption all over, like giant hives or nettle- 
rash. The anti-toxin itself has nothing to do with 
this, it is simply the horse-blood in which it is car- 
ried. Just as some people are naturally sensitized to 
strawberries, or cheese, or shell-fish, so that they 
"break out " and itch whenever they eat them, so the 
"blesse" who has been given one dose of horse's 
blood is sometimes sensitized against it in future. 
The rash fortunately is entirely harmless, but it is 
very disagreeable during the few days it lasts. 

At the Regimental Aid Post the live express 
package is "tagged " and labeled for his long journey. 
An orderly writes down upon a colored card a few 
vital details, his name, regiment, place and hour of 
wound, nature of projectile, and the surgeon adds 
nature of wound, kind of dressing applied, or opera- 
tion done, and whether anti-toxin or morphine has 
been given. Usually to be quite sure a colored cross 



THE HAPPY WARRIOR 103 

is marked on his forehead with an indelible pencil 
when the anti-toxin is injected. 

This card is slipped into a large envelope of tough, 
translucent, waterproof paper, closed at the upper 
end by a string running through two eyelet-holes, 
which is looped round his neck or tied through the 
buttonhole of his coat. Each place where he is ex- 
amined or handled or kept slips in another card of 
data, usually of a special color, with notes on his 
temperature, sleep, progress, etc. So that when he 
finally reaches either the last Base Hospital or home, 
the history clerk cuts the loop and takes out a com- 
plete history and clinical record of the case which he 
can copy into the hospital register. 

Where the roads are " unsanitary " our neatly 
tied up and labeled living packet may have to lie 
on his stretcher in the Aid Station till dark, when it 
is safe for the ambulance to come up, but if there is 
a good road he may be taken on a wheeled stretcher, 
which is not large enough to draw the enemy's fire, 
or, if a railroad track runs near by, on a hand trolley 
along that. 

In regions near a canal a big new barge is cleaned, 
painted, and fitted up as a spick-and-span floating 
Hospital or rather Dressing-Station and Ambulance 
combined, and the wounded carried directly to that 
and floated smoothly and luxuriously down to the 
Base Hospital. Nothing is overlooked in this war. 



104 THE DOCTOR IN WAR 

The wounded' s next stage will end at the Advance 
Dressing-Station, which used to be in a vacant build- 
ing, but now is usually in a cellar, or large cavern or 
gallery excavated underground. One that I visited 
was in the extensive cellars under the prison of a now 
world-famous little town with a Cloth-Hall. The 
wisdom of its being underground was sharply demon- 
strated the very day I was there, for twelve bearers 
had been badly wounded by a shell, in the courtyard 
above it that morning. 

Some of these Dressing-Stations are quite exten- 
sive, with caverns and galleries that will accommo- 
date four or five hundred men and a staff to corre- 
spond. One feature strikes you curiously as you go 
down into their mine-like entrance and that is double 
barriers across the passage of thick blanket curtains, 
about twenty feet apart. These are for protection 
against gas and form a sort of "air lock" so that 
the outer curtain barrier can be raised to allow the 
bearers to rush in with their burdens and dropped 
again behind them. 

Then the air in the "lock " is sprayed with a soda 
solution to neutralize the poison gas, and when it is 
cleared the second curtain barrier is raised and the 
wounded carried in safely without risk of letting in 
any fumes. The curtains themselves are kept moist- 
ened with a soda solution, for, by the mercy of 
Heaven, when the deadly strangling chlorine gas 



THE HAPPY WARRIOR 105 

comes in contact with moist soda, it is promptly 
transformed into harmless common salt or chloride 
of sodium. This is roughly the principle of the famous 
gas-masks. 

Some of these great cave-hospitals have apparatus 
for chemically purifying the air of fumes and pump- 
ing it in to supply their occupants all through the 
thickest gas clouds. 

The main danger against which these precautions 
are taken is gas-shells, shells which when they ex- 
plode belch out thick clouds of poisonous gas instead 
of shrapnel bullets. This gas is heavier than air and 
pours down any mine or cave openings like so much 
water. If Fritz can only spot, through his airmen, 
the opening of a cave hospital and spatter it with gas- 
shells he 's happy for a week. The idea of strangling 
the wretched wounded in their cots underground ap- 
peals strongly to his sense of humor. 

So constant is this gas danger that in the French 
Dressing-Stations and Field Hospitals, every occu- 
pied bed is obliged to keep a gas-mask hanging in its 
case on the wall close to its head, day and night. 

In the underground Dressing-Stations the patient 
is given a quick, skillful looking-over, to see if his 
wound is bleeding again, or his dressings have shifted 
in any way, and if he has bled heavily or is severely 
shocked, he may be given stimulants and warming 
drinks and kept for the night; or if an immediate 



106 THE DOCTOR IN WAR 

operation is urgently demanded, it may be done 
here. 

Some cases stand traveling very badly, like 
wounds of the brain or of the abdomen, and these 
may be kept and carefully tended here, for a week 
or more; but the vast majority get merely a swift 
looking-over and such operating as is immediately 
necessary, and as soon as darkness comes or the roads 
are free from shell fire, they are lifted into the ambu- 
lance again and rolled BacBtoward the Hospital. 

On their way they usually pass through another 
way-station, known as the Field Ambulance. The 
word " ambulance,' ' in military parlance, means 
three distinct and different things: First, the whole 
service and means of handling the wounded from the 
trenches back to the Casualty Clearing-Station. An 
Ambulance in this sense may consist of forty or fifty 
vehicles, ten or fifteen doctors, and one hundred 
orderlies and stretcher-bearers. Second, a Field Hos- 
pital of from fifty to one hundred beds, usually in 
tents between the Dressing-Station and the CCS. 
Third, the real ambulance or vehicle itself. A motor, 
often of a well-known, affectionately jeered at, in- 
expensive American make, fitted with a; high van- 
body, with bunk-like folding racks for stretchers on 
each wall, enabling it to carry four "liers " or eight 
"sitters'' ("couches" and "a pieds," as the French 
say) ; incidentally one of the greatest minor boons to 



THE HAPPY WARRIOR 107 

the safe collection and comfort of the wounded which 
Heaven has vouchsafed in this war. 

Here our pilgrim gets another swift, searching ex- 
pert "once over" to see that nothing is going wrong, 
and within a score or two of minutes more he is 
rolling smoothly down the well-paved military road, 
and circling up to the receiving door of the Casualty 
Clearing-Station . 

Here he is met by the surgeon on duty, with his 
orderlies and nurses, who, with the quickness born of 
much practice, run over his history cards, deftly re- 
move his clothing and undo or expose the dressings. 
From the appearance of these together with the his- 
tory, the surgeon promptly decides whether any 
operation is likely to be necessary or not. If not, he is 
borne swiftly off to the cleaning-up room of a ward, 
where the mud of the trenches is scraped off of him, 
and the blood washed out of his hair and finger-nails, 
and his whole body sponged and cleaned and alcohol- 

—in, „, 11 mi 1 "nid 

jrubbed. A bowl of hot soup or fragrant tea^TsTgiven 
him, and finally, cleaned and combed and resplend- 
ent in a gayly striped new suit of pajamas, he sinks 
with a sigh into the first clean soft bed with real 
sheets on it he has been in for months and enters 
upon the delightful adventure of getting well, with 
the chances thirty to one in his favor. 

If the wounded requires an operation, he is carried 
at once to the preparation-room of the operating- 



108 THE DOCTOR IN WAR 

theater. A very large majority do require an opera- 
tion in these days of shell-fire wounds when no one 
knows how many splinters of shell may be buried in 
the flesh ; when every corner of the wound is packed 
with germs from the soil, and the tissues not merely 
torn and cut, but parts of them so pulped and shat- 
tered that they must be cut and cleared away in order 
to allow the wound to come together and heal 
properly. In this preparation-room, he is swiftly un- 
dressed and washed and made as nearly aseptic as 
possible, the anaesthetic for the operation being given 
first, if the wounds are extensive and painful. Then 
the surgeon on duty carefully probes the wound with 
a gloved finger or sterilized forceps and gauges the 
extent of the injury and whether nerves, great blood 
vessels or joints are involved. 

If the case is an "average " one the surgeon pro- 
ceeds with the operation himself at once, but if it 
presents special features of difficulty or interest, he 
turns it over to the surgical specialist on the staff in 
whose province it belongs. For the staff of a Casualty 
Clearing-Station, while young and keen, are not 
merely fully qualified surgeons with from one to five 
years' hospital experience, but at least half of them 
have been specially trained in the surgery of some 
particular region. One, for instance, will have had 
special experience in surgery of the brain and spinal 
cord ; another, of the abdomen ; another, of the nerves ; 



THE HAPPY WARRIOR 109 

and another, of the joints. Many of the older ones 
had established reputations in their chosen field, be- 
fore the war; others, the younger, have been care- 
fully trained on the dreadfully abundant material 
since the outbreak in the great Base and Home Hos- 
pitals. They are a splendid body of men, with the 
fire and enthusiasm and progressiveness of youth, 
tempered by the experience and caution of age, and 
they all work together like one man for one object 
— the best interests of the wounded and the increase 
of surgical knowledge and skill. 

Each has his group of trained assistants and opera- 
tion nurses, and so superbly are they organized, and 
so splendid their "team-work," that it is no unusual 
thing for a staff of ten or twelve, working triple 
shifts, — that is, six hours operating, three hours 
rest, and repeat till finished, — to take care of four 
hundred, five hundred, even seven hundred patients 
in twenty-four hours. Indeed, one mammoth field 
hospital that I visited, with a staff of sixteen sur- 
geons and their squads, had actually dealt with four- 
teen hundred patients in the preceding thirty-six 
hours ! One of the surgeons told me that he had been 
in the operating-room from two o'clock one morning 
till six the next with only four hours' sleep, but he 
was going to sleep for a week now, to catch up. 

Lest anything should possibly be overlooked and 
the patient fail to get the utmost benefit of all the skill 



no THE DOCTOR IN WAR 

and knowledge in possession of the medical profession, 
these Casualty Clearing-Stations and all other Mili- 
tary Hospitals are provided with a staff of consul- 
tants. Men whose names are household words in the 
medical profession, not merely of England, but of 
America and all over Europe, who have abandoned 
huge and princely practices and for the mere pittance 
of an Army officer's pay, travel incessantly, up and 
down the whole zone of the armies, visiting every 
place where wounded are cared for, from the smallest 
Advance Dressing-Station to the hugest Base Hos- 
pital, advising, encouraging, assisting; placing all 
their skill and their fame and their experience at the 
service of the injured. 

If there is anything puzzling or unusual, or spe- 
cially serious and grave, or a delicate question as to 
the nature of the operation to be performed, all that 
is necessary is to send a telephone message on to the 
"D.D.M.S." (Director of Medical Service of the 
District), and one of these consultants will arrive at 
the Hospital next morning, or within a few hours, if 
the case be urgent. 

The superb hospital trains deserve a chapter to 
themselves. Arranged like Pullmans with permanent 
berths along both sides vestibuled together they carry 
from one to two hundred "cot'' cases and twice as 
many " sitters." They have complete kitchens and 
staffs, dressing-rooms, small operating room for emer- 



THE HAPPY WARRIOR in 

gencies, full staff of doctors and nurses and provi- 
sions and supplies for three days. In drives ordinary 
passenger cars are hastily transformed, seats turned 
into bunks, baggage or even box cars into kitchens 
and dressing-rooms. But all carry the wounded in 
comfort and perfect safety and the newer de luxe 
hospital in trains in positive luxury. 

To describe the perfection of the nursing service 
and general management of the Clearing-Stations 
and Field Hospitals would be a sheer waste of words. 
Every one who has visited a ward in a War Hospital, 
or who has had letters from a wounded member of his 
family, knows all about them, with their spotless 
linen, their bright-colored blankets and mattings, 
their flowers and their pictures. Everywhere woman 
has been permitted to go in this war she has made a 
little paradise of comfort and helpfulness. 

When it comes to the nurses themselves — trained 
or, volunteer, Red Cross or V.A.D., their skill, their 
unwearied devotion, their courage and self-sacrifice, 
one can only paraphrase the old Hindoo saying, 
" God could n't be everywhere, so he made nurses." 

In fine, the net result is that every wounded man 
on the Western Front, from the private to the general, 
receives unfailingly treatment and care which for 
effectiveness, perfection in every detail, and pitch 
of professional skill a millionaire might envy, and 
than which not all his wealth could purchase any 



ii2 THE DOCTOR IN WAR 

better. It is really difficult to imagine anything 
finer. 

Its results in cold, passionless figures speak for 
themselves. Of those surviving twenty-four hours, 
ninety per cent recover; of those reaching the Clear- 
ing-Stations, ninety-five per cent get well ; and there 
are many Base Hospitals which have " graduated'* 
tens of thousands of cases with less than one per cent 
of deaths! No wonder the wounded look cheerful! 

Their names are not so frequently mentioned in 
the dispatches as those of the commanders of the 
Line, but the Nation will never forget its debt of 
gratitude to the men whose skill and superb ability 
and devotion have organized and directed this mag- 
nificent service of life-saving; — Sir Alfred Keogh 
in England, and Sir Arthur Sloggett and General 
McPherson in France, with their devoted staffs and 
surgeons of the Royal Army Medical Corps, and in 
our American Army General Gorgas in Washington 
and General Ireland in France. , 



T 



VI 

A DAY IN A FRENCH FIELD HOSPITAL 
HIS is a war of initials and nicknames. Its 



greatest and most beloved General is "Papa 
Joffre," its most terrible explosive "T.N.T."; its 
favorite piece of artillery, the "Soixante-quinze" or 
"75" millimetres (bore 3 inches); the fine fighting 
men from the Colonies rejoice in the title of " Anzacs " ; 
and our own American soldier boys have been christ- 
ened "Amex."^ 

The Front itself fairly bristles with initials, and 
your guide-posts at every corner are white boards 
bearing bewildering arrangements of large black 
capital letters, some of which it would require the 
ingenuity of a Sherlock Holmes to interpret, though 
to the initiated they are as plain as print. 

If you are bent on errands or matters medical you 
should keep a sharp lookout for a sign with an " M " 
on it, either "D.M.S." (Director of Medical Service) 
or "S.S.M." (Service de Sant6 Militaire), according 
to the army you happen to be in. Only don't let 
another rather frequent sign with an "M " in it mis- 
lead you, for " A.P.M." (Assistant Provost Marshal) 
or "Police Militaire " will land you in the office of 
the Military Policeman, a very stern and dangerous 



H4 THE DOCTOR IN WAR 

person, indeed, with an insatiable thirst for prying 
into your private life and the dates and vis6s on your 
passes. 

So that when our chauffeur caught sight, through 
the dust of a crowded and teeming roadway, not 
many miles behind a rather lively section of the 
French Front, of a large board with the inscription 
in huge black letters, " H.O.E. No. 121," — this is not 
the real number or the censors would not have let it 
pass, — he knew that we had reached our destina- 
tion, and swung into the entrance way underneath it. 

These letters meant nothing, however, to my be- 
nighted eye, and after puzzling over them for some 
minutes, I followed my usual procedure and asked 
the courteous Surgeon Inspector of the Army, who 
was accompanying me, what they stood for. "Oh," 
he said, " ' H.O.' is for hospital and 'E' for 'evacua- 
tion,' and we call it 'Ashooway.' " And since a 
Frenchman actually does not know when he is or is 
not pronouncing an "h," it frequently comes out 
"Hashooway." In English it becomes "CCS." or 
Casualty Clearing-Station, and in our Army "Evacu- 
ation Hospital." 

Under whatever name it goes, however, it is a 
most useful and important institution in all three ar- 
mies, and, curiously enough, is quite outgrowing its 
rather singular name. Beginning as a small canvas- 
covered affair, with only a few dozen beds, where the 



A DAY IN A FIELD HOSPITAL 115 

wounded could be cared for overnight, or for a few 
days until they could be "cleared " or "evacuated" 
into the hospital trains or wagon convoys for trans- 
portation to the base, it has now grown into one of the 
most important hospital centers of the war. This 
was due partly to the comparative fixity of the Front 
which gave plenty of time to build railroads and 
bring hospital equipments and supplies close up to 
the firing-line ; partly to the blessed boon of the motor 
ambulance, which can carry a wounded man on aver- 
age roads ten miles, on good ones thirty, more easily 
than stretcher-bearers could one. As a consequence, 
a regular line of these houses of mercy has sprung up 
parallel with and from seven to ten miles behind the 
firing-line. 

The tents have been replaced by comfortable 
wooden wards. The operating-rooms are as per- 
fectly equipped and splendidly managed as in a high- 
class city hospital. An X-Ray Room, a Bacteriological 
Laboratory, bathrooms with hot and cold water, 
-electric lights, have been added and the two or three 
dozen cots have expanded to three hundred, six hun- 
dred, fifteen hundred beds, with a full staff of expert 
Surgeons and, best of all, of trained women nurses. 

/ The one which we had come to visit was an unusu- 
ally large one, containing nearly two thousand beds, 

_ and stretching its thirty-odd long wooden buildings 
along a ridge or shelf on the side of a beautiful val- 



n6 THE DOCTOR IN WAR 

ley just above a little river. Its " streets " converged 
toward, or ran parallel with, the double-tracked rail- 
road siding with high platforms from which the 
wounded could be lifted or wheeled directly into the 
waiting hospital train. 

At one end were the cook-houses and kitchens. At 
the other the Officers' Mess and the Nurses' Quar- 
ters. On the lower side, toward the river, were the 
disinfection and laundry and waste-disposal plants, 
while big double water- tanks — one for the chlorina- 
tion and the other for the storage of the water-supply 
— towered up in the center of the camp. 

The situation was a charming one: on one side of 
the valley, behind the camp, the ground rose quite 
abruptly until it reached a high, rounded hill, crowned 
with a quaint old stone-walled, gray-roofed village 
and topped by a great rough-hewn, thick-walled 
church — half cathedral, half fortress in appear- 
ance, which was a landmark for thirty miles. 

In front, on the other side of the river, the ground 
rose more gradually for a mile or two, then began 
to climb rapidly, and finally terminated in the blue 
wooded crest, clear-cut along the horizon, of a very 
famous and much fought-over Ridge, the Chemin 
des Dames. 

We climbed next day up to the fortress-like church, 
and found that nearly a third of its massive eight- 
foot walls had actually belonged to an ancient cathe- 



A DAY IN A FIELD HOSPITAL 117 

dral which the cur6 proudly assured us was a famous 
holy place before Rheims was ever thought of. In- 
deed, according to him, while the early French kings 
used to hold their show coronations in the upstart 
parvenu cathedral at Rheims they always used to 
come up here afterwards for a second ceremony to 
make sure that the crown was properly blessed on, so 
that it would stick. 

We were first shown a general plan of the hospital 
by the surgeon commanding, and then taken through 
it from the beginning — the point where the field 
ambulances swung up to the platform and delivered 
their burdens. 

First of all, the wounded man, or "blesse" is car- 
ried into the first of the so-called "Salles de Triage " 
or sorting wards. Here his name and regimental 
number, and if he is in condition to give it, the 
address of his family, are taken; his side arms and 
cartridge-belt are taken off and stored away, and 
his kit-bag and personal belongings and any money 
or other articles of value are tied up in a neat canvas 
bag, and deposited in racks until he needs them in 
the wards or is ready to be sent on from the hospital. 
Then a hasty look-over from the surgeon sends him 
into one of the two other " Salles de Triage" — 
that of the "Petits Blesses" if he is only slightly 
wounded and that of the "Grands Blesses" if he is 
more severely so. ' 



Ii8 THE DOCTOR IN WAR 

In the "petits blesses' ' division, there is a dress- 
ing-room with junior surgeon and staff, and the 
dressings already applied at the "Poste de Secours" 
or Field Ambulances are examined and replaced 
if necessary; then if the wounds are light, the 
"bless£" is sent into the huts or tents which form a 
sort of rest-camp, which is not under full hospital 
discipline, but where he is very well taken care of 
until, after a week or ten days, he is fit to go back 
again to the firing-line. To the same place are sent 
the men who have suffered slight accidents or strains, 
or whose digestion has given way, or who are out of 
sorts generally, without any fever or serious illness, 
but who would probably develop something more 
serious if they were not given a little rest and special 
care and feeding. These so-called rest-camps or 
"eclopes " huts have been found extremely useful in 
this war, as a means of relieving and quickly build- 
ing up again men, particularly of the older classes, 
who seem to be getting, in the expressive parlance of 
the street, "under the weather" or "off their feed" 
under the strain of trench life. A week of rest and 
comfort, with hot baths and massage and some extra 
delicacies in the way of food, often does wonders for 
them and sends them back feeling quite fit again. 

It was considered a rather quiet section of the 
Front at that time — though it has wakened up with 
vengeance since — but there was a steady trickle of 



A DAY IN A FIELD HOSPITAL 119 

wounded men into the hospital, ranging from fifty 
to one hundred cases a day. Three motor ambulances 
had just rolled up with their load, so that when we 
entered the third " Salle de Triage," we found eight 
or ten silent figures resting on their stretchers, wait- 
ing to be carried into the cleaning-up room for oper- 
ation. 

I say "silent " advisedly, for one of the most un- 
expected things, in this war of surprises, is the almost 
utter absence of any sounds of pain or outcry of any 
description from the wounded. I have seen wounded 
men literally in tens of thousands from within a few 
minutes of the time they were hit, through the various 
stages of dressings and operations, right back to the 
Base Hospital, and almost the only sound that I 
have heard out of their lips was that of cheerful and 
often joking conversation with their stretcher-bear- 
ers, their doctors, or their fellow "blesses." , 

Walk through the wards of a Military Hospital, 
whether a front-line . ambulance, "Ashooway," or 
Base, and you hear no more cries of pain than you 
would, say, in the surgical ward of an ordinary city 
hospital. Of course, there are exceptions, but they 
are scarcely one in thirty. 

Men with a badly shattered fracture, particularly 
of the thigh, men with severe shell wound of the 
abdomen, have a pretty uncomfortable time of it for 
the first few days, and can't help groaning or even 



120 THE DOCTOR IN WAR 

crying out in the night at times. Sometimes, too, a 
man who has been badly hit or lost a good deal of 
blood, or stunned so that his nerves are severely 
shaken, will whimper, half under his breath, in a 
curious sort of way, like a lost child waking suddenly 
in the night, and unable to make out where he is or 
what has happened to him. But this usually soon 
passes off when they have been made warm and com- 
fortable, and given hot soup and stimulants, so that 
their jangled nerves are brought back into tune again. 
Part of this cheerful quietness is due to sheer 
pluck and a brave determination to put the best 
face on the matter and encourage others. But 
part of it is due to purely physical factors. Most 
mercifully the one redeeming feature about the ter- 
rible shell wounds of this war is that they are not 
nearly so painful as a wound from the old-fashioned, 
slower-moving projectiles. They strike with such 
lightning-like speed and tremendous force, that they 
seem to crush and shatter and stun the nerves in 
their path into numbness, which sometimes lasts for 
several days. Indeed, this is no mere figure of speech, 
for one of the most serious difficulties in restoring 
movement and strength to badly broken or shattered 
limbs, after the wounds are healed, is the distressing 
frequency with which important nerves or nerve- 
trunks of considerable size have been cut or torn 
across, leaving the muscles below them paralyzed^ 




LADY LORRY-DRIVERS 




A CHEERFUL WOUNDED CANADIAN OFFICER BOARDING A 
HOSPITAL TRAIN 



A DAY IN A FIELD HOSPITAL 121 

The other factor is that the greatest pain and most 
prolonged agony of wounds is due to inflammation 
with suppuration and abscess formation, and these 
for the most part, in spite of the soil infections car- 
ried in on fragments of shell, modern surgery has 
been able to prevent; or, at least, by its methods of 
continuous flushing and cleansing and keeping open 
of the wounds, has avoided any blocking up with 
consequent rise of pressure, heat, and throbbing 
pain. 

Many of the men, in fact, express surprise that 
they should be laid up so completely by wounds 
which hurt them so little except when dressed or 
moved in some way. Often when quite badly 
wounded, they will declare that they did not know 
they were hit until one of their legs suddenly gave 
way under them, or their rifle dropped out of their 
hands, and for several seconds were quite puzzled 
to know what had happened to them. 

Surgeons, on the other hand, assured me that if 
they could secure a steady and abundant supply of 
laughing-gas, or nitrous-oxide, such as is used in 
dental operations, they would be able to perform a 
great many operations under that alone, because the 
tissues about the wound are so numbed that if the 
patient's brain, so to speak, can be numbed and put 
to sleep for a few minutes, the operation will be 
practically over before he regains consciousness. But 



122 THE DOCTOR IN WAR 

as both laughing-gas and the oxygen which has to 
be given with it can be carried only in large heavy 
iron tanks or containers, which are very inconven- 
ient to transport, this method is not generally prac- 
ticable in the front-line operating-rooms. 

From the "Salle" of the "Grands Blesses," the 
wounded man is carried into the cleaning-up room, 
which does not sound very romantic, but is one 
of the most indispensable portals of the military 
temple of healing. Here his soiled and blood-soaked 
clothes are removed, the mud of the trenches is 
scrapped and scrubbed and sluiced off him with warm 
water and alcohol, he is thoroughly insect-powdered, 
and put into clean bed garments. Then the skilled 
bearers of the operating squad lift him up gently and 
carry him into the etherization room, where, after 
a few pungent, aromatic, half-strangling breaths, 
he knows no more until he wakes to find himself in 
a clean, soft, comfortable bed, with hot- water bottles 
round him, a vision in white ready to meet his every 
want, and a thirty to one chance of rapid recovery. 
> Whichever ward of the "H.O.E." or "CCS." he 
awakes in, it will be much the same — long, light, 
clean, cozy, with a row of cots down each side and 
tables, usually decorated with flowers, down the 
center. The only difference between the wards is 
that usually each one has its distinctive tint of 
bright-colored counterpanes, or white counterpanes 



A DAY IN A FIELD HOSPITAL 123 

with a bright-colored blanket folded across the foot 
of each. 

As you enter the door of the "baraque" ward, you 
notice, especially upon your first dozen or so visits, 
one striking characteristic of all these war hospitals, 
and that is the astonishingly healthy, rosy, bright- 
eyed vigorous look of the patients. They were liter- 
ally in the pink of condition when they were hit; a 
few hours', or at most a couple of nights' good rest 
is abundant for their vigorous constitutions to make 
good whatever amount of blood they have lost. 
Their wounds, after they have been skillfully oper- 
ated on and dressed, pain them comparatively little, 
and except for being wound up in dressings or mum- 
mified by splints, they look as if there was nothing- 
whatever to prevent their getting right up and walk- 
ing out of the ward, and they are as ready for jokes 
or hilarious repartee as so many healthy, happy 
school-boys. 

They have an excellent appetite, a keen enjoy- 
ment of a smoke, a lively interest in the news of the 
day, and literally devour novels and other light lit- 
erature, by the dozen and hundred. 

My surgeon friends tell me that they will bring 
their novels with them into the dressing-room, lay 
them face downward on the nearest table while their 
wound is being dressed, and pick them up and plunge 
into them again the moment that the last bandage 



I2 4 THE DOCTOR IN WAR 

is in place and they are lifted and carried back to the 
ward. 

So quickly, in fact, does one come to expect this 
air of health and cheerfulness, as a matter of course, 
that one is positively struck by the exceptions. In one 
of the wards of this very hospital, I was walking down 
the center with the surgeon and head nurse, when my 
eye was suddenly caught by a sallow, languid, wearied- 
looking face, against a white pillow. So astonished 
was I that I instinctively and unconsciously stopped 
and the question leaped involuntarily to my lips, 
''Why, what's the matter with that man? He must 
be sick!" "Oh," said the surgeon, "he's just back 
from Salonica, and the wound has waked up his 
malaria again." 



VII 

THE RISKS OF A RED CROSS NURSE 

CLEAN and cozy and comfortable as were the 
wards of this great French Field Hospital, at 

M they were only a fair sample of those which 

are to be found all along behind the four hundred-odd 
mile battle-line of the Western Front, wherever it 
is considered safe and proper to have women nurses. 
There was a little attitude of conservatism, of re- 
serve, in the minds of the French Military Authori- 
ties on this question at the beginning of the war: a 
little survival, perhaps, of the attitude revealed in 
the half-alarmed, half-exasperated, most ungallant 
old-bachelor ejaculation, attributed to Lord Kitchener 
during the Boer War, "The Lord deliver us from the 
plague of women." Partly a feeling that it was against 
all the traditions and perhaps not quite proper for 
wounded men to be nursed by women in Field Hos- 
pitals under war conditions, and the demands that 
these involved. Partly a fear that women would not 
be satisfied with the primitive accommodations and 
plain diet of the campaigner. 

Deeper yet, though not perhaps so freely expressed 
from reasons of politeness, was the belief that, being 
the weaker and more timorous sex, they would be- 



126 THE DOCTOR IN WAR 

come unnerved and panicky under the conditions and 
threatenings of danger which are inseparable from 
hospitals in the field. 

But all these doubts and fears have been grandly- 
swept away and women have shown triumphantly 
in this war, as in every other when they have been 
given the opportunity, that their place is wherever 
suffering is; that if there be any place which is not 
fit for a woman to live and work in, let her in and she 
will make it so. 

She has won her way into and proved her priceless 
value in one line of Field Hospitals after another, 
wherever wounded men are kept and tended, right 
up to the Field Ambulances themselves, and the pro- 
gressive surgeons are urging her admission into some 
of the more stationary even of these. 

You can tell in an instant, just by looking in at the 
door of a Field Hospital ward, whether there are 
women nurses or not. Even if your eyes did not in- 
form you, your nose would. I have seen a good many 
Hospitals and Ambulance wards, where on account 
of danger or remoteness or some other reason, the 
wounded were being cared for only by men; and 
while they were well looked after, their wounds well 
tended, given plenty to eat, and their beds kept ship- 
shape in a good "farmhand " sort of fashion, yet there 
was not anything approaching that beautiful finish 
of neatness and tidiness, and what was more signi- 



RISKS OF A RED CROSS NURSE 127 

ficant that clean, blissful, comforted expression upon 
the faces of the patients that one sees in wards where 
women nurses rule. 

' No mere man will ever keep floors really clean, and 
beds white-sheeted and tidy, and windows hung with 
white curtains, except occasionally under severe naval 
discipline on shipboard, to say nothing of the score 
of slight but vital trifles which go to make up all the 
difference between a bunk-house and a cozy, com- 
fortable, homelike ward. 

Of course, it is possible to overdo it and make the 
men uncomfortably clean. In one beautifully kept 
ward, some of the Italian wounded privately and 
most apologetically explained to a sympathetic visi- 
tor, that while the lady nurses were angels and they 
could never say too much of their devotion and their 
kindness, yet they did think they were wasting much 
good water in washing and bathing them so care- 
fully every day. Lying in such a spotless bed in such 
a beautifully clean room, how could they grow dirty 
after they had been once well washed and bathed 
in the beginning? But usually they fairly revel in 
all the attention that is given them, although they 
would be perfectly contented with much less exalted 
and exacting standards. 

As for the hardships of campaign life, the nurses 
will take the plain board-walled shack assigned to 
them for quarters, and with little more than pic- 



/ 



128 THE DOCTOR IN WAR 

tures from the illustrated papers on the walls and 
flowers from the neighboring fields and gardens, a 
few strips of cheap matting on the floor and the hun- 
dred and one little feminine things and belongings 
that no true woman can be separated from, and which 
mysteriously find themselves wherever she goes, turn 
it into a cheerful, homelike, attractive bungalow. 

With dainty tea-service and the ever-available 
jams and preserves and tins of biscuits, with all the 
tribe of potted and canned goods, they can embroider 
and work wonders with the plain and substantial 
mess ration from the cook-house, and transform it 
into a dinner with courses. 

Our party was invited to afternoon tea in the 
nurses' quarters of this H.O.E., where we found a 
group of charming, white-uniformed, cultured, in- 
telligent women, French, English, and American, 
serving tea upon plain board tables surrounded by 
camp chairs, in a room whose bare board walls had 
been transformed into a cozy and tasteful summer 
cottage. And the tea, with thin buttered slices of 
war bread and biscuits and cakes and sandwiches 
from the inexhaustible resources of the brood of tins, 
was as excellent and varied and appetizing as if it 
had been served on a wicker table in a shady English 
garden. 

As for the steadiness of feminine nerves under 
trying circumstances, we happened to find an excel- 



RISKS OF A RED CROSS NURSE 129 

lent illustration in that very Hospital. We had n't 
gone far on our rounds through the wards, before 
my ear caught a curious, rather musical, prolonged 
whistling sound. At first I thought it was something 
blowing off from one of the numerous dynamo trucks, 
which were stationed here and there through the 
hospital, to supply electric light, hot water, or cur- 
rent for the X-Ray Room. But the third or fourth 
time that I heard it, I discovered that it seemed to 
be passing through the air, directly over our heads. 
Half suspecting the truth, I asked the lady superin- 
tendent, who was accompanying us, what it was. 
"Oh," she said, "that's just shells; they often do 
that. There 's a rail-head about three quarters of a 
mile behind us, and the Germans shell it regularly 
whenever they happen to think that there is any 
concentration of troops taking place there." "Well, 
but," I suggested, "some of the shells might get 
tired — spent, I believe is the proper technical term 
— and fall short of the rail-head, somewhere in this 
neighborhood." "Oh, yes," she said again; "they 
do, but not very often. One fell right in the middle 
of the camp, a few days ago; smashed through the 
roof of a small ' baroque,' but fortunately there was 
no one in it at the time, and it did not explode. A 
number nave dropped round the edges of the Hospi- 
tal camp. If you listen a few minutes you will prob- 
ably hear one of them beginning to clatter instead 



130 THE DOCTOR IN WAR 

of whine, which means that it is getting pretty nearly 
spent." 

So I listened, and sure enough, before very long, 
there came a rushing, whizzing sound, which sud- 
denly changed to a cluttery, clattery, clack, right 
over our heads, like a boy drawing a stick along a 
picket fence. "There," said the Sister, "is a spent 
one now." When we got to the upper end of the Hos- 
pital grounds, she led us to a little viewpoint from 
which we could look over toward the rail-head and 
see the strange birds that were whistling over our 
heads strike and turn, with a dull, sudden roar, into 
a great burst of thick brown smoke and showers of 
dirt. That tenor chorus, with the bass refrain, kept 
up at five or ten minutes' intervals steadily all 
through the afternoon, and only died away at that 
peaceful hour when almost everything stops, even on 
the battle-front — a couple of hours before sundown. 

"Well," I said to the Sister, "I suppose you will 
have a rest now, until the whistle blows for it to be- 
gin in the morning?" "Oh, no, the aeroplane bombs 
at night are far the worst." And of this, also,' we 
were fated to have actual demonstration. We still 
had another hospital to inspect, just on the edge of 
the village, below the church, and the staff most hos- 
pitably urged us to stay the night. But our inspec- 
tor had an important consultation engagement that 
evening, twenty miles away, and so we motored over 



RISKS OF A RED CROSS NURSE 131 

and slept there. When we came back in the morning, 
we found everything in a state of suppressed excite- 
ment. Four bombs had been dropped in the night 
by a cruising aeroplane, right between two of the 
"baraque" wards. One of them fortunately was 
empty and it was the worst hit, torn and riddled and 
shattered in every direction by the fragments of 
shell; but in the other, two patients were killed and 
five or six wounded, among the latter, a nurse. What 
particularly interested us personally was that this 
empty ward which had been so badly riddled was 
probably the place where we should have been put to 
sleep if we had accepted the invitation and spent the 
night there ! 

Later I learned that the bombing at night had 
become so constant and so serious that the hospital 
had to be cleared of its wounded and temporarily 
abandoned. As it had forty-odd buildings and nearly 
two thousand beds, there could have been no pos- 
sible mistake as to its character. 



VIII 

GAS-GANGRENE AND TETANUS. 

THE goodness or badness of a thing depends 
entirely upon its surroundings, where it finds 
itself, as the French say. We have heard much from 
time immemorial of the healthfulness of close con- 
tact with Mother Earth, of getting back to and in 
close touch with her fertile and sustaining surface, 
her soft brown lap. 

From its abundance comes all our sustenance, 
from labor in its brown furrows comes half our health ; 
nay, we are officially informed that out of its dust our 
own bodily frames were originally made. But that 
was a very, very long time ago, and to-day to mix 
any more of the dust of the earth into our bodies, 
whether into our lungs or into our blood, is anything 
but a health-giving affair. 

It is all very well for us to get right down and delve 
into the soil, but when the soil begins to delve into 
us, it is another matter. Dust of the earth, in the 
lungs to-day, spells tuberculosis; dust in the stomach 
means typhoid ; dust in the blood, gas-gangrene and 
tetanus. 

Of course, these troubles do not spring from the 
actual substance of the earth itself, in one sense, — 



GAS-GANGRENE AND TETANUS 133 

the sand or the clay out of which it is made. But in 
another sense they spring from the soil itself; that 
is, from elements which are an essential part of the 
soil, which in fact make the surface of the earth 
into soil, and without which there would be no life 
whatever possible upon the face of the earth, only 
a barren stretch of desert sand and sun-baked clays 
— the bacteria of the soil. 

The soil, in fact, is alive, not dead, and bac- 
teria are the life of it. Broadly speaking, the fertility 
of the soil depends upon the number of bacteria in 
it, and all our laborious and elaborate methods of 
cultivation both age-old and modern, ploughing and 
harrowing, disking and dynamiting, draining and ir- 
rigating, are simply to enable more billions of bac- 
teria to flourish in a given soil. 

Consequently the richer and more superbly culti- 
vated the soil is, the more literally alive and swarming 
it is with bacteria, and indeed in market-garden soil, 
for instance, the bodies of the bacteria, infinitesimally 
tiny as they are, form in the mass actually as much as 
ten per cent of its bulk. Most of these bacteria of the 
soil, if they happen to get into the blood or into the 
body, either die at once or produce only putrefactive 
changes in the food in our intestines, because they 
cannot "eat" or grow upon living tissues. 

Only one, the typhoid bacillus, has learned the 
trick of living in the intestines; one more, the germ 



134 THE DOCTOR IN WAR 

of tuberculosis, the trick of nesting in the lungs; and 
only two, the tetanus germ and the gas-bacillus, 
that of living under certain conditions in wounds. 

Against the tetanus bacillus we have an effective 
weapon, a certain shield in the form of the tetanus 
anti-toxin. By the mercy of Heaven, the tetanus germ 
is extremely slow in starting to grow in a wound, so 
that if a dose of the anti- toxin is injected into the 
blood, within one or even two days after the wound, 
though preferably within a few hours, it protects the 
body against its invasion. 

Against the gas-bacillus we had no such direct 
remedy, so a new line of defense has had to be worked 
out. This germ, under ordinary circumstances and 
conditions, attracts very little attention from sur- 
geons or from human beings. He is a peaceful and 
blameless agriculturist living in and on the soil, at- 
tacking and breaking up the decaying animal and 
vegetable matters contained in it, and preparing 
them for absorption by the roots of the plants, while 
at the same time getting his own living "on the side." 

In the course of this beneficent process, the ba- 
cillus produces a considerable amount of gas, as 
indeed is a quite common habit of many of the ba- 
cilli, illustrated by the frothing and bubbling which 
takes place in the ordinary processes of fermentation, 
in canned fruit, wine, beer, bread-raising by yeast, etc. 

This gas in the soil is perfectly harmless, indeed 



GAS-GANGRENE AND TETANUS 135 

probably rather beneficial than otherwise, by in- 
creasing its porousness and assisting the growth of 
other bacteria. But when it gets into the human body 
and begins to liberate it in the tissues, then some 
very distressing effects are produced, and it is this 
fact which has given to it its name — now all too 
familiar. 

When a group of these gas-producing bacteria in 
the soil are blown on a piece of shell deep into the 
human body they find themselves in clover. The 
fragments of the tissues which have been torn and 
crushed and mangled out of all vitality by the shells 
furnish dead animal matter for them to grow upon. 
They are deeply enough buried to be freed from the 
thing they hate most — the oxygen of the air; and 
the warmth of the body "forces" them like a hot- 
house. The result is that after about forty-eight 
hours, the edges of the wound begin to swell up 
and turn outward or backward, making it open. 
The discharge from the wound almost stops, and 
its cut surface takes on a curious half-jellified, half- 
mummified sort of look; then the whole wounded 
limb begins to swell up and distend in the most ex- 
traordinary fashion, turning, as it does so, first an 
ashy white and then a greenish color. 

This is because the tissues are being literally blown 
out with the gas, and on pressing the finger down on 
this balloon-like swelling, a distinct crackling or tiny 



136 THE DOCTOR IN WAR 

bubbling sensation can be felt. The gas and the 
swelling extend on up over the surface of the body, 
bloating it, and distorting its shape; the patient be- 
gins to complain, not so much of pain as of a sense 
of great restlessness and depression and dread of what 
is coming next. His face is white and pinched, his 
lips bluish, his eyes widely distended and "all pupil,' ' 
his temperature, instead of rising, goes steadily down, 
down, and unless something can be done to stop the 
terrible march death ends the scene within forty-eight 
hours, sometimes within twenty-four of the first ap- 
pearance of gas in the tissues. 

Small wonder that both surgeons and wounded 
stood aghast at such a swift and deadly process of 
destruction when it first began to show its horrid 
front in our spotless and speckless war hospitals on 
the Western Front as it did in thousands in the early 
days of the war. Our last experience with anything 
resembling it had been with the dreaded hospital 
gangrene of our American Civil War. 

This was probably a mixed infection, a gas-bacillus 
combined with a pus germ, Streptococcus or Staphy- 
lococcus, though we shall never know with certainty 
because it was before the days of Lister and Pasteur, 
and germs had then not been " invented.' ' Its prog- 
ress was somewhat slower, but it was furiously con- 
tagious, so that it would run through whole wards, 
and every case coming into an infected hospital, 



GAS-GANGRENE AND TETANUS 137 

even though suffering from the merest scratch, would 
catch it and have a desperate fight for his life. As 
nearly half of those attacked by it died, it was one 
of the most terrific scourges known to the history of 
surgery; and when its infection once got into a hos- 
pital, that hospital had to be emptied and closed and 
the patients turned out into tents. 

This present gas-gangrene never became a tenth 
as bad as that, for it had just one redeeming feature, 
and that is it is not actively contagious or inclined to 
spread ; which was probably because modern surgical 
precautions were able to bar out the pus-forming 
germs and prevent them from forming that "wicked 
partnership" with the gas-bacillus which gave its 
infection wings, so to speak. 

As we have only just recently developed an anti- 
toxin, for three years of struggle and experiment 
we were driven to hunt for other weapons. The first 
hold which we got on the germs came from the fact 
that they are what are known as "anerobic"; that is 
to say, can live without air, and not only that, but 
are killed by, or grow very slowly in, the presence of 
air and oxygen. This being the case it was quite 
evident that our modern aseptic method of closing and 
sewing up all wounds tightly at the earliest possible 
moment, was exactly in the wrong direction, and in- 
deed was giving the bacillus the very thing that he 
most wanted, airlessness and warmth. Consequently 



138 THE DOCTOR IN WAR 

it became the rule to leave all shell wounds of any 
considerable depth, or of pocketed, irregular shape, or 
with mouths much smaller than their deeper parts, 
as wide open as possible for the first three to five days. 
This at once diminished the number of our cases of 
gas-gangrene. 

The next step was the discovery that, as the bacil- 
lus could not eat, or live upon living tissue, if we could 
manage to clean and cut away and scrape out of the 
wound the crushed and shattered fragments of flesh 
whose vitality was destroyed, we should deprive him 
of any food to live upon or material to grow on. 

When this was thoroughly done, within four or five, 
or in circumstances where it was necessary, within 
thirty-six, hours of the receiving of the wound, our 
cases of gas-gangrene took another and much heavier 
drop. In fact, these two methods of "ventilation" 
and thorough cleaning brought them down to scarcely 
one tenth of their former prevalence. 

Finally, it was found that while the gas-bacillus, 
when looked for by microscopic methods, would be 
found in two thirds or even three fourths of all the 
wounds of a given hospital, and that many of the 
cases had not been for various reasons able to be 
given thorough cleaning-out of the wounds, yet the 
vast majority of them all would escape any real gas- 
infection. And, what was the important point, most 
of those who did develop even a moderate degree of 



GAS-GANGRENE AND TETANUS 139 

gas-gangrene were cases in which some other cause 
of depression was at work — they had had severe 
hemorrhages and lost a lot of blood, or they had 
fallen in No Man's Land, or in a shell crater in the 
middle of a great battle and had to lie out in the mud 
and rain or snow for six, eight, twenty, or even thirty- 
six hours before they could be brought in and at- 
tended to; or they had been ill or in bad condition 
from some cause before they were wounded. 

In short, all conditions which tended to lower the 
vitality of the wounded man, or which lowered the 
vitality of the tissues in his wound by lack of timely 
and prompt attention, increased the probability of 
a gas-infection. The first and second of these pre- 
ventive steps, namely, the thorough cleaning-out of 
all dead or dying tissues in the wound, technically 
known as " debridement,' ' are steps in the now fa- 
mous and magnificently successful Carrel treatment, 
and wherever that is introduced gas-gangrene sinks 
almost to the vanishing point, though unfortunately 
not quite. 

Furthermore, as the Medical Service on both the 
French and English Fronts has become more per- 
fectly organized, and particularly as spur lines of 
railroad and trolley lines have been used for the 
transportation of the wounded, these distressing de- 
lays have become much less common, except when the 
system is swamped by tens of thousands of wounded 



i 4 o THE DOCTOR IN WAR 

in a few days from some great battle, and cases of 
gas-gangrene have gone down in like proportion. 

Even before we had any anti- toxin defense against 
gas-gangrene, we had brought it down to a really 
encouragingly low figure. For instance, I spent three 
full weeks on the Western Fronts, in the early spring 
of 1 91 7, visiting new hospitals every day and seeing 
tens of thousands of wounded, and in every hospital 
that I entered one of my first questions was: Have 
you any typical cases of well-marked gas-gangrene? 
Only once was it answered in the affirmative, and that 
in the last hospital but one that I visited and when 
I was in despair of ever seeing a case. 

There were a number of cases in which there was 
some slight puffing and glazing of the wound, but 
upon promptly applying the principle of " letting in 
the light" — or rather air — by slitting open the 
tissues freely in all directions around the wound, and 
putting in Carrel tubes if not already in use, nine 
tenths of them would clear up promptly without any 
further trouble. In a series of later trips to the French 
Front I found bad cases of this distressing condition 
almost equally rare. 

Within the last few months Dr. Flexner, of the 
Rockefeller Institute, has perfected an anti- toxin 
against gas-gangrene which is giving excellent re- 
sults, and which has given the finishing touch to our 
victory over gas-gangrene. 



GAS-GANGRENE AND TETANUS 141 

Incidentally, it may be said that there is a curious 
confusion, quite common in the public mind, between 
gas-gangrene and poison gas on the Front. Both 
are among the blessings of war, but other than that 
have not, of course, the slightest connection. One 
form of the confusion is the idea that gas-gangrene 
is the result of gas from the bombardments getting 
into the wounds! But vile and abominable as gas- 
clouds and gas-shells are, and heavy the disgrace 
and we hope punishment of the German brutes who 
invented them, their gas, chlorine, has no injurious 
effect upon wounds even if it happens to be blown 
into contact with them. On the contrary, though 
somewhat irritating, it would have a distinct anti- 
septic effect. 

Operative surgery for the last thirty years has been 
a singularly open and above-board game, with all 
the cards on the table, and clear, definite rules. If 
you played according to the rules, you won, in the 
sense of swift healing, "union by first intention," 
as it was called, — no fever, no pus. If you lost by 
so much as a single drop of pus or a degree of tem- 
perature, it was because you had used bad judgment 
or overlooked something. 

The tissues of a healthy body contain no pus 
germs; the skin has only a few feeble types occasion- 
ally inhabiting it; hence, if the patient's skin was well 
washed and sterilized, and the surgeons and nurses 



142 THE DOCTOR IN WAR 

kept their hands and gloves and dressings surgically 
clean and sterile, there would be no germs in the 
wound and consequently no pus and no fever. 

So confident and so conscientious were some great 
operators that they actually had printed and hung 
up in their hospital wards cards with the motto, 
"Every patient whose wound suppurates has a right 
to demand the reason of his surgeon." 

Feeling sure that there were no germs anywhere 
in the wound, and that therefore there would be no 
"matter" or pus to provide for, draining by rubber 
tube or gauze strips was unnecessary. The wound 
could be closed at once, its sides brought carefully 
together and stitched almost as tight and smooth as 
a tailor would patch a rent in a coat. 

In most operations which had not been done on 
account of some inflammatory or infected condition, 
the deliberate aim was to leave no gap or cavity any- 
where even in the deepest part of the wounds, but 
to bring both walls or lips of it firmly together from 
bottom to top. And surgeons vied with each other 
in devising ingenious forms and combinations of 
stitches which would produce "perfect coaptation": 
usually at least two sets and sometimes even three or 
four of stitches — a deep one, of silkworm gut or even 
wire, to draw the deepest parts of the wounds to- 
gether, one or two intermediate layers of stitches to 
draw together the muscles and the fatty and connec- 



GAS-GANGRENE AND TETANUS 143 

tive tissues under the skin ; finally, a row of very fine 
catgut or silk to bring the skin together almost as 
smoothly and accurately as a glove-maker would 
stitch a seam in a glove — in fact, one of the most 
popular skin stitches is known as the "glove-maker 
stitch." 

Some surgeons would deftly put in this last row of 
stitches from below, catching only the under surface 
of the skin, without piercing it at all, so that when 
this " underground " zigzag was drawn tight, the lips 
of the wound came smoothly together without any 
sign of stitches. And as all the other rows of stitches 
were buried deep in the wound, there was nothing 
whatever to be seen but a thin red line along the skin 
where the wound had been. These buried stitches 
or sutures were of catgut or silkworm gut, because 
these being animal tissues would be melted and ab- 
sorbed by the fluids of the body in the course of a 
week or so. 

But with the outbreak of this war all this finesse 
had to be thrown to the winds. Just imagine the 
change, the humiliating descent from this. scientific 
accuracy, this faultless handiwork, and kidglove 
embroidery finish, to the clumsy, wide-open, free- 
drainage methods, which were the only ones appli- 
cable or possible in dealing with the jagged gashes 
and caverns and craters, torn by high explosive 
shells. Gone were our cherished dreams of sterile 



144 THE DOCTOR IN WAR 

wounds, of perfect closure, of hairline skin sutures 
and narrow scars. We were thrown right back to 
the old rule-of-thumb, pre-antiseptic motto, "Cut 
through everything soft, saw through everything 
hard, and tie everything that bleeds." 

At first we made a noble, half-despairing attempt 
to preserve our beautiful technique and perfect 
finish. We cleaned out the ragged, blackened, gaping 
wounds as best we could, we tied the bleeding ar- 
teries, we trimmed up their ragged edges, stitched 
them together in as neat a seam as possible, and 
"trusted in an all-wise and unscrupulous Providence," 
as a surgeon cynic in one of the big field hospitals 
remarked. 

We did not have long to trust, for the prompt re- 
sult was an explosion of gas-gangrene and tetanus, 
such as we had n't seen for sixty years; indeed, we 
had fondly imagined that we never should again. 

Of course, shell wounds in this war were nearly five 
times as numerous as ever before, but still we had 
had quite a considerable experience in shell wounds 
in the Boer, Spanish-American, and Russo-Japanese 
Wars, and never anything like this as a result. 

We were not left long in doubt — no sooner had we 
scraped up a little of the soil of the battle-field, dis- 
solved it in water, and put it under a microscope than 
we found it swarming with tetanus germs, and another 
germ criminal, known by the musical and poetic title 



GAS-GANGRENE AND TETANUS 145 

of Bacillus gasogenes (perfringens) , also, to be f>er- 
fectly exact, Welchii, in honor of its discoverer, the 
famous Dr. Welch, of Johns Hopkins University. 

The tetanus bacillus caused the lockjaw, and the 
other germ, with a name like a Spanish hidalgo, 
caused the gas-gangrene. So the mystery was solved. 

Why had n't we got similar results from our shell 
wounds in the Boer War and the Russo-Japanese 
campaigns? A little further investigation and re- 
flection quickly told us. The Boer War had been 
fought chiefly over barren naked veldt or rocky hills, 
with scarce a trace of cultivation about them, and 
the Russo-Japanese War had been fought over a 
richly cultivated country, but one in which little or 
no horse manure had been used as a fertilizer, for the 
reason that there were extremely few horses. The 
battles of the Western Front were on the most in- 
tensively cultivated and heavily fertilized land in the 
world, enriched chiefly by stable manure, and as the 
normal habitat of both the tetanus bacillus and the 
gas-bacillus is the intestines of the horse, the soil was 
simply swarming with them both. 

Once we had seen the enemy he was soon ours. 
A message flashed to the laboratories on both sides 
of the Atlantic set them turning out the tetanus 
anti-toxin, literally by the gallon. The Laboratory 
of the Health Department of New York City alone, 
for instance, supplied over seventy-five thousand 



146 THE DOCTOR IN WAR 

dollars' worth of anti-toxin and typhoid vaccine in 
one year. Every severely wounded man was given 
a preventive injection, and lockjaw swiftly declined 
to the vanishing point, where it has been held ever 
since. 



IX 

HEALING THE WOUNDS OF WAR, ^OR THE 
CARREL TRIUMPH 

THE trench seems to have put its stamp on the 
whole of this war. Even the wounds inflicted 
in it are almost trench-like in their depth, their com- 
plexity, with traverses, saps, and branches reaching 
in every direction, and above all in their difficulty of 
drainage. At first sight one's feeling is one of as- 
tonishment that such a network of burrows, such a 
system of underground works could have been con- 
structed in the human frame. 

I have seen a surgeon thrust his sterilized gloved 
hand in under the shoulder blade behind, and bring 
it out under the arm-pit in front, with plenty of room 
to move his arm up and down; and yet, the lung 
having marvelously escaped being penetrated, and 
the nerves and arteries not torn across, the man made 
good recovery, with a fairly useful arm. 

In another "bless6," a powerfully built " Chasseur 
a pied," there was a cavity in the great muscles of 
the lower part of the back which looked as though 
a small-sized shrapnel shell had buried itself down 
to the backbone, and then exploded. Mercifully, the 
spinal cord was unhurt. The walls of the huge crater, 



148 THE DOCTOR IN WAR 

into which you could have packed a half-dozen 
oranges, were as clean as a fresh-caught trout. The 
man was making rapid progress toward recovery, 
though it would leave a scar about the size of a 
frying-pan. 

Another young Hercules, a "Diable Bleu," who 
lay waiting his turn on the operating table, was 
pointed out to me by the surgeon as having fourteen 
different wounds large enough to count, — and they 
don't count little ones on the Front, — and yet his 
pulse and color were good, he stood the operation 
finely, and in a few days he was considered out of 
danger. 

What men kept in perfect condition can stand and 
what surgery can do are two of the marvels of this 
war. The problem before the surgeon was a compli- 
cated one, like the wounds. They were deep, irregular, 
pocketed wounds, not only very difficult to drain and 
close smoothly, but also packed with bacteria of the 
soil, carried upon the fragments of the shell. These 
bacteria, coming from the depths of the soil, and liv- 
ing on decaying vegetable and animal matter, found 
just the conditions that were needed for their growth, 
in the depths of the shell- wound ; that is, absence of 
oxygen or air, and the presence of dead or dying 
animal matter in the flesh destroyed and shattered 
by the shell fragments. 

In the earlier days of the war before the problem 



THE CARREL TRIUMPH 149 

had been solved, they did so flourish and produce 
a good deal of gas-gangrene. The wounds were so 
irregular and many-pocketed, the dirt containing 
the bacteria driven so deeply into the flesh itself, 
that it was impossible to get them clean, in the sense 
of clear of bacteria, by any process of washing or 
scrubbing however vigorous, and the consequence 
was that these bacteria were constantly dropping 
into the cavity of the wound for days or weeks after 
the injury. It was impossible to clear them out 
before they could begin to grow and produce their 
poison, even by dressing the wounds twenty times 
a day, had this been feasible. 

The only thing, apparently, to be done was, so to 
speak, to attack them in their lair, by keeping the 
wounds constantly flushed with some fluid capable 
of destroying the growth of the germ. ( 

Scores of surgeons and bacteriologists were work- 
ing on this problem, but it was first perfectly solved 
by the genius of a brilliant young French surgeon, 
Alexis Carrel, born and educated in France, who had 
lived for years and won national reputation in Amer- 
ica as a discoverer and research worker in surgery. 

Carrel's method of attack against these wound 
bacteria was a twofold one: first, depriving them of 
the food on which they could live; second, poisoning 
them as fast as they came out of the walls of the 
wound, before they could begin multiplying or get 



150 THE DOCTOR IN WAR 

a first foothold. His first great advance was his dis- 
covery, after months of careful observation in the 
hospital and experiments in the laboratory, that these 
bacteria could not live upon living tissue, and that, 
therefore, in cleaning the wound out at the first dress- 
ing or operation, it was not necessary to get rid of all 
the bacteria, but only the dead and damaged frag- 
ments and surfaces of the tissue which would furnish 
food for them to live upon. 

This simplified the problem considerably, for while 
it was impossible to get rid of the bacteria buried down 
in the flesh, it was practical to clean the wound, so 
as to get rid of all the tissue that was dead or likely 
to die. 

Of course, it is not always possible to do such a 
cleaning completely in deep and extensive wounds, 
and, for instance, as a surgeon with whom I talked 
put it, with a touch of high dramatic exaggeration, 
" If I were to trim away all the badly damaged tissue 
in some cases, I should have to trim away half my 
patient." But in the great majority of the cases a 
very searching and thorough house-cleaning of the 
wound, called by Carrel "debridement," can be car- 
ried out with such excellent effect that one of the 
most prominent of French surgeons assured me that 
a thorough " debridement" was nearly two thirds 
of the battle for recovery, and was almost the most 
important part of the Carrel treatment. 



THE CARREL TRIUMPH 151 

But the motto of the surgeon must be "thorough." 
No matter how huge or gaping the wound, or how 
broad the scar appears likely to be, so far from sav- 
ing every scrap and vestige of skin that is possible, 
so as to close it over the wound, the surgeon delib- 
erately goes round the whole edge of it with his 
scissors or scalpel, and cuts off a strip one third or 
one fourth of an inch wide, because experience shows 
that, although it even looks healthy,, it has been so 
badly damaged by the slash of the shell that it is 
certain to break down and become a source of infec- 
tion to the wound. * 

Then the wound is explored by sterilized fingers 
and drawn open as widely as is safe and feasible, 
to get a clear sight of its sides and bottom, and all 
particles of torn, crushed, or badly damaged flesh, or 
fragments cut off from their blood supply, are cut and 
scraped away. As a final touch a pad of gauze is 
drawn over the end of some blunt instrument, and 
the whole inner surface of the wound scrubbed and 
scraped with it. 

In wounds that go right through from one side of 
the limb to the other, I have seen a good-sized strip 
of gauze pushed through, and then the surgeon takes 
hold of the two ends, one in each hand, and saws 
backwards and forwards through the wound, so as 
to clean out thoroughly every scrap of badly dam- 
aged tissue. 



152 THE DOCTOR IN WAR 

This thorough scrubbing-out and "laundrying" 
of the wound takes time and trouble and looks at 
first sight rather drastic and heroic for the patient, 
but he is, of course, under ether, and feels nothing, 
and the rapidity with which wounds will begin to 
heal after a thorough cleaning and " debridement' ' 
is something most gratifying. 

So striking and unmistakable are the benefits 
of this thorough " debridement* ' that practically all 
surgeons, and even advocates of other methods of 
treating wounds in war, are in favor of it.- In fact, 
some are so delighted with it that they claim to 
have invented it themselves, or attempt to deny 
that it is an essential or original part of the Carrel 
treatment. But the documentary evidence is fatally 
against them. 

The second great step is that of the continual ir- 
rigation of the wounds with an antiseptic fluid strong 
enough to kill the germs; but not irritating or dan- 
gerous to the tissues of the body itself. This last re- 
quirement is by no means as simple as it sounds, for 
ever since the very first discovery of antiseptics by 
Lister, the medical profession had been driven more 
and more strongly to the conclusion that almost all 
antiseptics capable of destroying germs were even 
more capable of damaging the tissues of the body. 
To put it very briefly, we were more easily poisoned 
by them than our germ visitors were. 



THE CARREL TRIUMPH 153 

So far had this conviction gone that the vast ma- 
jority of surgeons objected to the very name " anti- 
septics," which means literally, " against infection," 
poisoning the germs after they had got into the wound. 
They insisted upon a new term, invented after Lister, 
''asepsis," which means "without infection," never 
allowing any germs to enter the wound from the 
patient's body, the surgeon's hands or instruments. 

The majority of our surgical operations within the 
last twenty years have been carried out on this 
aseptic plan, using no germicides on the instruments 
or surgeon's hands, and nothing at all in the wound 
except sterilized water or a little alcohol. So that it 
was entirely against our modern, and already tra- 
ditional, practice and ideas to attempt to use anti- 
septics for the purpose of killing the germs in wounds. 
A hundred eager objections were made to prove at 
once that any antiseptic fluid was necessarily a poison 
to cell life, and must be far more dangerous to the 
cells of the patient's body than to the germs. This 
accounted, in considerable degree, for the tremen- 
dous prejudice and opposition on the part of many 
doctors to the Carrel treatment in the beginning, 
a prejudice that was scarcely creditable to the open- 
mindedness of the medical profession. 

The Dakin-Carrel antiseptic fluid might and even 
should do more damage to the patient's body than it 
did to the cells themselves, but there was absolutely no 



154 THE DOCTOR IN WAR 

denying or getting away from the fact that a patient 
treated with it got well in less than half the time 
than under any other, and even though a few cells 
be destroyed, the millions left seemed to be invigo- 
rated by the process. The Carrel treatment, even 
with its innumerable modifications, has done more to 
save life, save limbs from amputation, to diminish 
suffering and hasten recovery than any other surgical 
procedure of the war. 

One of the most striking features of this war is the 
way in which strange and unexpected things have 
suddenly become enormously in demand, expensive 
and difficult to get in proportion. If, for instance, 
twenty years ago any one had mentioned rubber or 
cotton as among the most vital necessities of war, he 
would have been laughed at. Now one of the sternest 
practical difficulties which concerns the hospital is 
how to rescue enough rubber for its purposes from 
the maw of the ever-devouring motor, and cotton for 
its dressings from the seething vats, in which the soft 
innocent stuff is turned into fierce and deadly explo- 
sives of the gun-cotton and nitro families. 

In the case of rubber, the doctor has the slight 
consolation of knowing that part of this keen com- 
petition is between two humanities: the rubber tires 
of the blessed and unspeakably useful motor ambu- 
lance, as against his gloves and irrigation tubes. It 



THE CARREL TRIUMPH 155 

would scarcely be too much to say that these two 
uses of this curious vegetable gum have done more 
to lessen the sufferings of the wounded than any 
other two non-human agencies in this war. The old 
proverb should be revised to read, "There's nothing 
like rubber." 

One of the greatest practical difficulties which the 
spread of the Carrel treatment had to fight, next prob- 
ably after the native inertia of a certain type of 
surgical mind, was the scarcity and expensiveness of 
rubber. The second part of the Carrel method, which 
comes after the " debridement," requires rubber tub- 
ing literally by the yard for every patient. 

It was painfully easy for those who on various 
grounds were not willing to adopt the treatment to 
cry out, "Oh, we can't possibly secure all that quan- 
tity of rubber tubing, or stand the expense if we could 
get it." But as the total cost of an irrigation equip- 
ment, averaging five yards of tubing, flasks, nozzles, 
clips, and all included, is a little under three dollars 
and it lasts a month, that argument does not survive 
much investigation, considering that it shortens the 
time of healing, on an average one half, and in some 
cases more, saves the patient's strength by diminish- 
ing suffering, and markedly lessens the necessity of 
amputations. No good business man would ever 
hesitate over the question of investing such a sum. 

For instance, one of the best-known American 



156 THE DOCTOR IN WAR 

surgeons in France, Dr. Blake, has the proud record 
of treating a thousand successive cases of serious 
wounds under a modified Carrel method, with only 
four amputations ; and the position of his hospital was 
such that only grave cases — mostly bad fractures, 
and fully one third of them raising serious question 
of the need of amputation — were sent to it. 

The equipment for irrigating every nook and 
corner of the wound is the most ingenious part of 
the Carrel treatment, and from the fact that it is 
also the most visible, the one that is constantly to 
be seen in operations at all hours, by all visitors 
to the ward during the whole weeks-long course of 
healing, it has come to be looked upon as being the 
treatment itself. 

In one sense it is extremely simple, merely a pear- 
shaped glass flask, known as an "ampoule," suspended 
from an upright rod fastened to the head of the bed, 
with a long rubber tube leading from its lower open- 
ing down to the wound, and there breaking up into 
a large number of smaller tubes. The rim of the 
mouth or upper opening of the ampoule is flared out, 
so that it can be easily held by a clip or a cord, and 
it is raised about three or four feet above the level 
of the mattress to give the pressure that has been 
found necessary properly to flush the wound. 

At first sight it might be thought that a single 
tube inserted into the deepest part of the wound 



THE CARREL TRIUMPH 157 

should be sufficient to flush it; but this was very soon 
found to be insufficient. Water has a most fiendish 
and ingenious way of hunting and finding promptly 
the shortest way out of a particular pocket, and then 
flowing slowly and blissfully along that course, leav- 
ing almost untouched all the rest of the area that it 
is supposed to be irrigating. 

This was first met by tying up the tube at the bot- 
tom of the wound and punching from ten to twenty 
holes in its side, so that the water would start back 
from a dozen points instead of one. But even this 
was not sufficient, so a smaller blind tube with side 
perforations was passed into the bottom of every 
one of the pockets and corners of the wound, and 
this method was found to meet the situation and to 
attack and overcome the germs in their own dens. 
So that if you look closely at the dressings of a 
beautifully clean and comfortable "bless6" under the 
Carrel treatment, you will find that the large tube 
leading down from the ampoule to the wound ends 
just above the dressings in a little glass distributor, 
or forked tube, breaking up into as many branches 
as there are smaller tubes required to reach every 
pocket of the wound; for two pockets there will be 
a simple " Y," for three, four, or five, more, a curious 
little multiplier of the shape of a comb with hollow 
back and teeth. 

A very large and deeply pocketed wound may have 



158 THE DOCTOR IN WAR 

as many as ten or even twelve tubes. Naturally the 
placing of these numerous tubes judiciously and care- 
fully, so as to keep every corner of the wound flushed, 
is a question of skill and careful irrigation on the 
part of the surgeon. 

Now comes the question of the flow of the fluid. 
At first sight it would appear that a gentle, continu- 
ous irrigation would be decidedly the best method, 
secured by a very slow, continuous flow all day and 
all night. Accordingly, a very ingenious drop by 
drop apparatus was introduced into the big tube, 
and a gentle, soaking, continuous flow adopted. This 
worked admirably and is still Dr. Carrel's personal 
preference for the treatment of surgical cases. 

Other surgeons, on the other hand, who enthusi- 
astically adopted the Carrel treatment, declare that 
in their experience this method has the disadvantage 
that as the pressure under which the water flows is 
decidedly low, these little openings at the side of 
the tubes — which, of course, are very small, hardly 
larger than a good-sized darning-needle — are apt 
to become clogged up by scraps of lint, matter or 
pus, and then the fluid begins to short-circuit itself 
out of the wound by another channel. 

Another objection, which is rather a serious one 
practically, is that the business of the water being 
to find its way out of the wound as continuously 
as it is poured in, first saturates the dressings and 



THE CARREL TRIUMPH 159 

then overflows from these out over the bedding and 
clothing of the patient, and finally, if not most in- 
geniously headed off by rubber sheetings, into the 
mattress itself. 

The method which they prefer is the alternate 
one, also discovered by Carrel, of short flushings at 
regular intervals. A spring clip is put on the long 
tube and the nurse releases this every two hours by 
the pressure of her fingers, and allows the water to 
flow for a period depending on the size of the wound, 
on an average three minutes. This gives sufficient 
force to drive any clots or obstructions out of the 
little holes in the tube and to force water into every 
corner, like a broom; and also, from the nursed and 
hospital management point of view, it enables them 
to watch the result of the flow and to check it as soon 
as the flooding appears on the surface of the wound, 
thus avoiding a good deal of troublesome overflowing 
and leaking which is quite uncomfortable for the 
patient. Carrel himself, however, holds that the 
very best ideal results can be obtained by the con- 
tinuous flow. 

This is the standard or "full" form of the treat- 
ment, but there is another modification of it which 
may be used, in first-line Field Hospitals, for in- 
stance, or under other circumstances which render 
it difficult to secure or erect the flush tanks or am- 
poules; that is, putting the numerous little tubes and 



160 THE DOCTOR IN WAR 

distributors into the wound as usual and then flush- 
ing out at regular intervals^ by the use of a glass 
syringe. 

Carrers collaborator, Dakin, has devised a special 
glass syringe of very simple shape, that can be 
easily sterilized, and one is provided for each patient, 
so as to avoid risk of infection. This method of flush- 
ing with a syringe is one of the earlier ones adopted by 
Carrel, to be abandoned later in favor of irrigation. 
It does not give as perfect results and means more 
work and trouble for the attendants, but it may be 
used as an emergency substitute, when the ampoules 
and long tubes are not available, with quite satis- 
factory results. It has also the practical result of 
reducing the cost of the total equipment by about 
one third. 

Last comes the question of the antiseptics that 
should be used in the fluid. The situation in this cam- 
paign is not unlike the historic epigram of Henry of 
Navarre, on fighting in Spain. He declared it was such 
a poverty-stricken, hard-hitting country, that if you 
went in with a small army, you were beaten; with a 
large one, you were starved. In order to get some 
antiseptic that killed the germs without doing more 
harm to the tissues of the patient, after many skill- 
ful and patient experiments by Dr. Carrel and Dr. 
Dakin, a young English physiologic chemist who 
was Dr. Carrel's associate in this part of the work, 



THE CARREL TRIUMPH 161 

the ingenious idea was hit upon of devising an anti- 
septic which within a short time would be neutralized 
or made harmless to the tissues by the lymph that 
flowed into the wound, and yet which within that 
time would have been able to destroy or prevent the 
growth of the germs present. 

The chemical which they found to fulfill all these 
different requirements and give best practical re- 
sults was not a new one, but a modification of an 
old medical friend and stand-by, bleaching powder, 
popularly known as " chloride of lime," or "eau de 
javel" in France. 

This sloppy white powder, which we have all seen 
and smelt sprinkled about sinks, laboratories, and 
wherever disinfection is supposed to be in order, like 
a good many other common things is rather a com- 
plicated body. But the secret of it, put very crudely, 
is that it contains and conveys a small amount of 
the extremely powerful and poisonous germicide and 
disinfectant, chlorine gas, and this while very irri- 
tating at first, soon after coming into contact with 
the fluids of the body and their large content of so- 
dium is changed into a harmless chloride of soda, or 
common table salt. 

Grotesque and almost incredible as it may sound, 
this same poisonous and irritating gas — chlorine — 
which can be used to kill germs and heal wounds, 
is the one which is the chief constituent of the 



162 THE DOCTOR IN WAR 

terrible poison gas-clouds and gas-shells as originally 
devised by the Germans, and the change to harm- 
less common salt, which takes place in the Dakin 
solution in wounds, is the same one which enabled 
the soda-moistened folds of the earlier gas-masks to 
protect our soldiers. 

The Dakin solution, of course, required the most 
elaborate and delicate modification of the chlorine 
powder, first to get it of the exact mean of strength 
strong enough to do its work, but not strong enough 
to harm the patient, and then to neutralize, as the 
chemists say, its alkalinity or "soap-likeness," so as 
to prevent its irritating the skin of the patient under 
the dressings after it had flowed out of the wound. 
This was finally found to be best done by a careful 
addition of boric acid, and the perfected antiseptic, 
"Dakin's Fluid," is a marvel of ingenious and deli- 
cate adjustment to the particular work it has to do. 
It is customary to color the completed fluid pink with 
some harmless dyestuff, so that the nurses can see 
the level of it in the glasses and ampoules, as any 
one will see if one visits the hospitals, but this has 
nothing to do with its antiseptic effects. 

Finally comes the interesting and important prac- 
tical question. How do we know that this ingeniously 
adapted solution is doing the work required of it, 
killing the germs and promoting the healing of the 
tissues? To find the answer to this question the most 



THE CARREL TRIUMPH 163 

painstaking and thorough research and experimental 
work of any part of the process were carried out by 
the Carrel staff. It is impossible to give more than the 
very rudest explanation, but it may be roughly said 
that track of the progress of wound toward recovery 
is kept by two entirely separate methods, which 
keep check upon one another. 

One is the daily counting of the bacteria which are 
present in the depths of the wound itself. At the 
time of each dressing, delicate instruments are intro- 
duced into the depths of the wound, bringing back 
drops of the fluid present. These are spread upon mi- 
croscopic slides, stained, and the number of bacteria 
contained in five or ten dips counted. If the wound 
is doing well, the number of bacteria should diminish 
markedly from day to day, and when they have 
fallen to a very low level and remained there for 
several days, it is then considered safe to do the thing 
so dear to the heart of the modern surgeon, which 
under pre-war conditions would have been the first 
step; that is, putting stitches into the lips of the 
wound and sewing it up tight. 

The method is of peculiar value, because in the 
open treatment of wounds, the great difficulty is in 
knowing just when it is really safe to close them. 
This is vitally important, because, if they are allowed 
to granulate up from the bottom, it takes an enormous 
length of time, and what is almost as undesirable, 



164 THE DOCTOR IN WAR 

leaves a huge and not only disfiguring but crippling 
scar. 

A wound of great length and extent successfully 
treated by the Carrel method can finally be closed up 
and healed, with only a little more scar or deformity 
than would be left by the closing-up at once of a clean 
wound. This method diminishes the risks of crippling 
and the number of cripples very markedly. 

As for amputations, an eminent French surgeon 
made a collection of over two thousand done in the 
earlier days of the war, and found that seventy per 
cent of them were made on account of severe infec- 
tions of the wound, and at least two thirds of these 
could have been prevented by the Carrel method. 

The other method of keeping track of the progress 
of the wound is the simple, but rather laborious, 
one of measuring its actual superficial area. Care- 
fully graduated calipers are employed and the most 
elaborate mathematical formulae for calculating the 
square surface used, as well as tracing the actual shape 
and size of the wound on transparent paper, then 
transferring it to the pages of the record. 

On the basis of thousands of cases followed and 
recorded after this fashion, Carrel has actually been 
able to work out a mathematical formula for the rate 
at which a wound of given size and depth in a patient 
of a given age, ought, under proper conditions, to 
heal. 



THE CARREL TRIUMPH 165 

It would be tedious to go into details, but the 
omnipresent and universally employed " curve* ' has 
been utilized. A line of curve is plotted that shows 
the rate at which a given wound, of this size 
ideally treated, ought to heal, and another curve is 
plotted from the bacteria-count test, and the two 
curves are found to run closely parallel. It gives you 
an almost uncanny feeling to be shown, in the his- 
tory room of Dr. Carrel's splendidly equipped hos- 
pital at Compiegne, a diagram showing what is the 
rate at which a given wound ought to heal. This was, 
perhaps, laid out fifteen days ago; the case is still 
in the wards; you go and see what his actual curve 
of progress has been, and it is seldom that the two 
curves differ more than five or ten per cent. If the 
surface of the wound ought to be, say fifty square 
centimeters on the fifteenth day following, it will 
usually be between forty-five and fifty-five square 
centimeters in area. 

Then, with this as a basis and standard, a most 
careful process of testing out different antiseptics and 
methods is gone through with, including all the rival 
solutions which have been suggested by other sur- 
geons or improvers upon this method. It was fas- 
cinating to note how promptly and certainly a rapidly 
falling curve of bacteria in a wound would turn and 
rise within twenty-four hours after some less efficient 
form of antiseptic had been employed, and how it 



166 THE DOCTOR IN WAR 

dropped back to the normal again after this had been 
discontinued. 

Several other antiseptic solutions besides the Dakin 
were found to give excellent results for some time, 
in cases that had started toward recovery under the 
Dakin, but upon more prolonged trial it was found 
they could not be relied upon to meet complications, 
which arose in the form of new outbursts of germ 
growth in the wound, and the Dakin had to be gone 
back to to bring these under control. 

It would be hard to imagine anything more abso- 
lutely founded upon cold, actual demonstration and 
test, and the feeling conveyed is irresistible that if 
any other fluid suggested had given better results 
than the Dakin, the latter would have been promptly 
and ruthlessly discarded in its favor. 

Incidentally, it may be remarked that the age of 
the patient was found to have a striking influence on 
the curve and the rate of recovery. The younger the 
soldier, the more rapid the healing in the beginning, 
which supports the preference of military authorities 
for young recruits. On the other hand, there was 
a curious after-check, and that was that although 
the wounds in the older men healed much less rap- 
idly at first, they began to catch up later and in 
the end healed not only as firmly and solidly, but 
within fifteen or twenty per cent as soon as in the 
youngsters. 



THE CARREL TRIUMPH 167 

The older man's power of healing is slower in the 
beginning, but it arrives in the long run. Some day, 
as I suggested to Dr. Carrel, half jokingly, it may be 
possible to get from this rate of wound healing some 
sort of mathematical test as to what is the real age 
of a man. But, of course, no one would venture to 
hope for any such certitude about the age of a 
woman. 



THE STRANGLERS 

THIS is a gas war. Not, alas! a gas-bag war, in 
the sense of long-distance windy contests as be- 
tween World's Champions or Mexican Revolution- 
ists, but in the sense that gas is the life breath of the 
whole "show." Gas hurls and explodes its shells and 
shrapnel; propels its airplanes; pushes its monster 
guns, its motor "camions," its ambulances; drives its 
submarines and their chasers; fills the domes of its 
censors ; and serves directly as one of the most grue- 
some of its deadly weapons. Less directly and ob- 
viously it heals the wounds and purifies the drinking- 
water, for the very same deadly chlorine which makes 
up the bulk of the gas-clouds is the antiseptic in the 
Carrel treatment, and in the sterilizer in the bleach- 
ing powder used to purify the drinking-water of the 
armies. 

And of all the features of this most terrible of wars 
which have attracted the most horror-stricken at- 
tention and produced the most world-wide outburst 
of disgust and loathing against Germany, poison gas 
is easily chief. It is hardly too much to say, in the 
language of the standing form of newspaper reports 
of suicide, that when Germany turned on the gas 



THE STRANGLERS 169 

she blew out her brains, so far as hope of finally 
winning the war is concerned. And when the much- 
debated question of the name by which this titanic 
world-struggle shall go down to history is finally 
settled, it may easily happen that its title will appear 
as "The Great Gas War." 

And it would be distinctive, for it is the first, and 
will most emphatically be the last, in which this 
atrocity is permitted, unless God has abdicated in 
favor of Germany. On my trips to the Flanders 
Front, the most striking signs which met the eye 
everywhere, in the squares of the little villages, on 
the walls of the public buildings, and Headquarters, 
along all the roads leading to the Front, were great 
posters blazing the word "Wind safe" or "Wind 
dangerous" for gas attacks; though, I am happy to 
say, for reasons explained later I only saw the "Dan- 
gerous" signal two or three times in as many weeks. 
And as I first looked over the kit of the soldiers most 
of its contents looked quite familiar: there was the 
haversack, the blanket-roll, the canteen, the mess- 
tin and cup, the revolver, the rifle, but one prominent 
object struck the eye as new and strange. This was 
a large rectangular case, or box, about fourteen inches 
square by three or four inches thick, slung from the 
shoulder or round the neck like a pair of field-glasses. 
Across its face was printed in large staring letters 
some dramatic warning in Italian; for instance, "Chi 



170 THE DOCTOR IN WAR 

si leva la maschiera muore!" — "Who leaves the 
mask dies!" 

Gas has proved a great disappointment to its in- 
ventors. There is abundant evidence to show that 
when the German General Staff started their clouds 
of strangling chlorine rolling across the level flats 
of Flanders toward the Canadian trenches before 
Ypres, they confidently and gloatingly expected 
either to send their defenders flying headlong in panic- 
stricken terror, or to suffocate them where they stood, 
and then come forward and pick up the pieces and 
occupy the position at their leisure. But they swiftly 
bumped upon the two rocks which have wrecked their 
whole programme of gas-drives ever since. First, 
that determined troops with any kind of a wet cloth 
tied over their mouths and nostrils will hold their 
ground in the thickest of gas-clouds. Second, that 
if you make your gas-clouds thick enough seriously 
to embarrass the enemy, you find them extremely 
uncomfortable for your own troops to charge into 
for at least one half to three quarters of an hour 
afterwards. 

While part of the Canadians fled, coughing and 
gasping, before the ghastly, green, choking cloud — 
and who could blame them, utterly unprotected and 
unwarned as they were — a few stood their ground 
doggedly and died in agony, while the remainder, 
a considerable minority, hastily grabbed up or tore 



THE STRANGLERS 171 

off pieces of any sort of cloth that they could lay 
hands on — first-aid dressings, handkerchiefs, shirts 
— and bound them respirator fashion across their 
noses and mouths. 

This helped, but it was n't enough. Like a flash 
an inspiration came to one big Canadian sergeant. 
He tore off his dry bandage, saturated it by a method 
which is as primitive as it is unfit for publication, 
tied it on again, and found he could breathe with 
comfort. He ran down the line shouting his discovery. 
Man after man followed his example, and when the 
German shock-troops came stumbling blindly but 
confidently through the twilight of their own gas- 
cloud, to occupy the deserted trenches, they met such 
a hot and hornet-like reception that very few of them 
went back across No Man's Land to tell the story of 
their failure. 

And this was a fair sample of the luck that has 
attended gas-attacks ever since. It is hardly too 
much to say that gas in clouds has proved the great- 
est false alarm of the war. In a few instances, where 
it has been used upon " gas-green " troops — that is 
to say — raw levies — either unprovided with gas- 
masks or untrained in their use, as once or twice, for 
instance, on the Galician Front on the Dunajec River, 
and once on the Italian Front, — it has produced 
headlong flight; but it is the opinion of some military 
experts and particularly of those on Boards of Gas 



172 THE DOCTOR IN WAR 

Warfare, that it has seldom determined the result or 
even turned the scale in a single important battle. 
But when first sprung as a surprise on unsuspecting 
raw troops it was sometimes a ghastly success. 

When used against seasoned troops with good 
gas-masks, though it unsettles their nerves and an- 
noys their finer susceptibilities extremely, instead of 
running away they have a habit of holding their 
ground, and taking out their exasperation on the 
storm-troops that follow the gas-cloud. While the 
protection of modern masks, with reasonable vigi- 
lance and intelligence, is so nearly perfect that while 
precise figures are withheld for obvious reasons, it 
is, in the opinion of those who are in a position to 
know, doubtful whether the deaths from gas exceed 
one or two per cent of the total mortality of the 
war. In fact the only danger of its further use in 
future wars is the fact that it has not proved as 
deadly or as cruel as was hoped by its inventors. 

For instance, on one mountainous section of the 
Italian Front which I visited, where very few gas- 
attacks had been attempted by the Austrians on 
account of the height and direction of the almost 
incessant mountain winds, one summer afternoon it 
fell calm and still, and the fiends saw their chance 
for a choice bit of "Schrecklichkeit"! From the 
upper end of a long, sloping, high-walled valley, 
filled with men and horses at their evening meal, they 



THE STRANGLERS 173 

launched their murderous clouds, and in twenty sec- 
onds the whole glen was a hell of agony and death. 
Men, horses, mules rushed madly down it, strangling, 
gasping, fighting, trampling upon one another in a wild 
rush to escape the deadly fumes, but in vain. Some of 
the soldiers had laid aside their masks, some rushed 
panic-stricken downhill without waiting to put them 
on, others pulled them on and then, feeling half suf- 
focated in their rush, tore them off again to breathe 
freer. When at last the fates took pity and a sunset 
breeze lifted the strangling clouds, nine thousand 
men lay gasping and choking in agony, and four 
thousand of them died, in spite of the most heroic 
efforts of the doctors! "It was a glorious victory," 
but Heaven help the man or men to whose account 
it will be charged in the great Book of Judgment, the 
verdict of history! Moreover, it was utterly barren 
in a military sense, as before the valley was clear 
enough of gas to allow the Austrians to advance down 
it, the Italians had thoroughly lined its sides and 
rim with machine guns. 

In the minority of cases, in which it is successful 
in driving back the enemy, it probably gains small 
amounts of ground at lower cost of life than either 
shell- or rifle- fire. 

But it punishes the poor wounded terribly, for 
most of the Dressing-Stations have to be under- 
ground, and hence are liable to be " flooded " with 



174 THE DOCTOR IN WAR 

gas, which runs down like water and strangles them 
like rats in a hole. Most Dressing-Stations I visited 
in Flanders had an "air-lock" at the entrance con- 
sisting of a heavy blanket-curtain soaked in soda 
solution, which you lifted to enter. Then it could be 
dropped behind and your clothing sprayed with a 
soda spray if a "cloud" was on, then another wet 
blanket in front of you was lifted and you entered the 
tunnel ward. 

Like almost everything else in this supposedly 
most modern and scientific of wars, there is nothing 
new about the use of poison-gas. The famous stink- 
pots and smoke-makers of both Oriental and Mediae- 
val warfare were exactly the same in principle and 
intention. For although the horrible reeks which they 
gave off were for the most part as harmless as they 
were abominable, they were regarded as extremely 
deadly and held in terror by the warriors on both 
sides, on account of the ancient mental association 
between vile odors and demons and devils and black 
magic generally. 

In fact, this method of warfare was invented long 
Ijefore the human species, the most ancient and 
honorable practitioner of the art being a little beetle, 
styled by the French "le bombardier," who when 
frightened discharges a jet of most vile-smelling and 
acrid gas or spray in the direction of his enemy. His 
shot is most ingeniously fired, too, the stink mixture, 




TRANSPORTING WOUNDED TO A FIELD DRESSING-STATION ON 
THE SALONICA FRONT 




BRINGING IN A WOUNDED CANADIAN THROUGH THE MUD 
ON THE WESTERN FRONT 



THE STRANGLERS 175 

which is acid, being suddenly discharged into a little 
cavity under his tail shell, where it meets an alkali, 
is turned into a gas, and exploded, by the force of its 
own expansion, through the muzzle of his tiny trench 
mortar. Of course, the oniony " tear-gas " spray of 
the sable and silver nocturnal disturber of the peace 
of our poultry yards is a household word. The Ger- 
man Board of Gas Strategy can proudly cite before 
the next Hague Conference precedents as ancient as 
they are appropriate, in the skunk and stink-bug. 
, There is abundant evidence that the German chem- 
ists and their laboratory staffs, under the direction 
_■ of the Great General Staff (like everything else in 
! Germany or under a German hat, for the last half- 
century), had been experimenting industriously for 
years to decide upon a poison gas suitable for use in 
war. This is proved partly by the capture of gas- 
containers stamped with the dates " Model of 1909" 
and " Model of 191 1 " — I happen to have been per- 
sonally assured of this fact by a member of the Bel- 
k gian Relief Commission who had seen gas-cylinders 
so dated ; partly by the fact that the Germans were im- 
porting drugs which were of no possible value except 
for the manufacture of " tear-gas " ; and partly because 
the very first gas that they used — chlorine — has re- 
mained the chief staple of their gas-clouds ever since, 
showing that it was the survivor of a long and rigid 
series of elimination tests. 



176 THE DOCTOR IN WAR 

The masks used against gas-clouds were simple 
face bandages dipped in a solution, first of ordinary 
baking or washing soda, later of sodium hyposul- 
phite, such as is used in developing photographs, 
because it lasted longer and was less irritating to the 
skin, and cans or jars of this solution were kept stand- 
ing about in the trenches to moisten the masks when 
they dried out. Those simple soda solutions, by one 
of the blessed miracles of chemistry, combine with 
the burning, strangling chlorine gas and turn it in 
a flash into harmless common table salt (sodium 
chloride) ! Later a little glycerin was added, because 
by its power of attracting moisture it kept the masks 
from drying up so quickly. 

This was all very well as a temporary measure, and 
these little home-made, hand-dipped masks did yeo- 
man service in many a gas-cloud for several months. 
But when it had been recognized that gas was going 
to prove a permanent institution in this war, some- 
thing more business-like and more effective was called 
for. This took the form of a helmet or bag of twenty 
or thirty layers of gauze with goggles of glass or cel- 
luloid for the eyes, pulled on over the head and cap 
or helmet, much like the veils used by bee-keepers, 
and then tucked down under the coat-collar and 
buttoned in. 

This was a great improvement, because it not 
only protected the lungs from the poison gas, but also 



THE STRANGLERS 177 

the eyes from "tear-gas," but it was hot, stuffy, and 
greatly limited the field of vision as the disks of glass 
or celluloid hung some distance out in front of the 
eyes. Moreover, it was found that when phosgene gas 
began to be extensively used, the bag or helmet mask 
was a very imperfect protection against it. 

So the War Department called in the chemists and 
physiologists and the inventors and put their wits 
to work, with the result of producing about two 
years ago a mask which is an almost perfect protec- 
tion against every known kind of gas which German 
deviltry has been able to invent, which can be worn 
if necessary from twenty-four to forty-eight hours at 
a stretch, which one can sleep in, fight in, play foot- 
ball in if desired. 

It is far and away the best mask in use in all the 
armies, and has been adopted in its entirety with cer- 
tain additions and improvements by our American 
army. Some of the French troops use it, and when 
the Russians were still our allies, a considerable num- 
ber of these good masks were supplied to them. But 
most of the French, and all the German, Austrian, 
and Italian troops, are still supplied with a very 
inferior mask of the "nose-bag" type, whose sole 
advantage is that it is cheap, light, and easier to 
carry than the more elaborate English and American 
"box" type. 

For obvious reasons, no details of the construe- 



178 THE DOCTOR IN WAR 

tion of this mask can be given except roughly to say 
that the air is purified of gas by being drawn in, 
not through layers of gauze, but through an oval 
box of about the size of a tomato can, filled with 
whole layers of different chemicals and absorb- 
ents which can be added to or altered at will, as 
new gases are introduced. As this box respirator 
hangs down upon the chest at the end of a rubber 
tube the size of a large garden hose, this combined 
with the goggles gives a curiously elephantine, or 
extinct monster-like appearance to the face of the 
wearer. 

Some of the German and Austrian masks also have 
a box respirator, but these are far inferior in neutral- 
izing and protecting power to the English and Ameri- 
can ones. The feature which makes the mask comfort- 
able for such long-continued wear, is that the breath 
or expired air of the wearer passes directly out into 
the open air through a valve instead of being retained 
within the mask to heat and sweat and suffocate him. 
With this mask snugly strapped on, our American 
and English boys are perfectly safe in the densest 
and most poisonous of gas clouds. 

Gas warfare had become a whole department and 
science in itself, first in the German, and later and 
most reluctantly in the Allied armies. But unfor- 
tunately the whole filthy idea is so utterly repugnant 
to our sense of decency and fair-play that we have 



THE STRANGLERS 179 

so far contented ourselves chiefly with countering 
against each fresh deviltry of the Hun instead of 
getting right down to play the dirty game whole- 
heartedly and give him as good as he sends and one 
better. 

There are now in use three main groups of gases, 
each containing two or more. First of all, the poison 
gases proper — chlorine and phosgene ; then come 
the tear-shells, or, to give their dictionary name, 
lachrymatory gases, which is the same thing done 
into the Latin, whose object is simply to irritate in- 
tensely the eyes and produce such a flood of tears 
as temporarily to blind the soldier. Last and most 
troublesome of all come the irritant gases which at- 
tack chiefly the surface of the skin; these are mus- 
tard-gas, nitro-chloroform, and a derivative of picric 
acid. 

Then to make matters still more complicated, any 
or all of these gases instead of being discharged in 
clouds are fired over in shells containing tubes of 
them compressed into liquid form with just enough 
explosive to scatter them through the air. Indeed, 
mustard gas can be used only in shells, because it is 
not a gas at all, but a heavy liquid, and has to be 
scattered through the air in the form of a spray by 
some explosive. 

¥ Phosgene is a child or near relation of chlorine, its 
textbook name being carbonyl chloride. To put it 



180 THE DOCTOR IN WAR 

very roughly, it is a combination of chlorine and 
choke-damp (carbon monoxid) with all the bad quali- 
ties of both parents. It is probably the most intensely 
poisonous gas known, being fatal in about one twen- 
tieth of the concentration required for chlorine and 
has the ghastly trick of producing relatively little 
discomfort or suffocation while it is being inhaled, 
and then suddenly toppling over its victim dead of 
heart failure several hours later. 

It is in itself the answer to the frequently asked 
question — "Why don't the Allies use prussic acid 
and strangle the whole Hun outfit?" Prussic acid 
to the Prussians would certainly be most appropriate, 
but unfortunately it is not nearly so deadly as the 
less famous phosgene, and has the great drawback 
of being light volatile, and so rapidly escapes into 
the surrounding air that it soon becomes too weak to 
be dangerous. 

Phosgene derives its almost musical name from 
the curious fact that the two gases which compose 
it can be got to unite only in the presence of bright 
light. Hence, its Greek title, " light-born.' ' A literal 
child of light, but most emphatically not of sweetness, 
and a doer of deeds of most sinister darkness. 

It is much more to be dreaded than chlorine, be- 
cause it is not only ten times as poisonous, but is 
almost invisible and has a much less powerful odor. 
The latter is a sweetish, rather aromatic scent, offi- 



THE STRANGLERS 181 

cially described as resembling that of violets, though 
to my untutored olfactories it more nearly suggested 
garlic. A full-blown cloud of chlorine and phosgene 
combined is a literal "holy terror/ ' blasting and 
withering every living green thing, grass, leaves, gar- 
den crops along the whole of its front to a depth of 
two or three miles, and killing birds, insects, and 
small animals, three and even four miles behind the 
front trenches! The only living thing that can sur- 
vive it is men or horses in gas-masks, and it has one 
small redeeming feature, that it destroys all the 
vermin in the trenches and dug-outs; not a rat, nor 
a cockroach, nor even a flea or a cootie being left 
alive. 

The cloud-attack method of using poison gas proved 
a great disappointment to the Hun chemists and com- 
manders, and has already been practically laid on 
the shelf for the past year or more in favor of gas- 
shells. Indeed, it was a good deal of a boomerang, 
and even more unpopular among the German troops 
than it was among our own. This for the reasons, 
first, that there was a perfectly tremendous amount 
of extremely hard and dangerous work in preparing 
for an attack, thousands of the great gas cylinders 
weighing from ninety to one hundred and twenty 
pounds, having to be carried by hand into the front- 
line trenches, at the rate of one to each yard of the 
two to four mile front to be gassed. Indeed, in some 



182 THE DOCTOR IN WAR 

of the last attacks they were placed three to every 
two yards! 

In the second place, this whole process was lit- 
eral playing with fire, for if a single fragment, from 
any one of the continual rain of shells falling into 
the front-line trenches happened to strike a cylinder, 
there would be at least a dozen dead and thirty to 
fifty badly gassed Germans at once. Third, and not 
least, by a strange oversight on the part of the All- 
wise-and-everything-fore-thinking General Staff, they 
failed to take into account that the battle-line of the 
Western Front runs mainly, roughly speaking, from 
north to south, and that the prevailing winds of the 
temperate zone during the summer are from two 
thirds to three fourths of the time from the westerly 
quarters. Therefore, the wind is favorable for carry- 
ing Allied gas-clouds into the German trenches just 
about three times as often as it is for carrying Ger- 
man clouds into our trenches. 

To make it worse yet, not only high winds, but 
any winds above ten miles an hour whisk the gas 
about and scatter it so quickly as to make it almost 
harmless. The only winds upon which gas-clouds 
can be used effectively — the light ones from four to 
eight miles an hour — are the very ones which are 
most likely to whirl about and carry the cloud back 
into, or what is even worse, up or down, the German 
trenches. And even the good old German God has 



THE STRANGLERS 183 

declined to interfere and correct this strange perver- 
sity of the weather, in favor of his chosen people. 

In one blessed instance the wind, after chopping 
about and holding the cloud in No Man's Land for 
twenty minutes, swung completely round and swept 
it back into the Hun trenches killing eleven hundred 
and disabling over five thousand of their own soldiers. 

One of the first methods of attacking and dispersing 
the gas-clouds themselves was literally fighting the 
devil with fire. That is to say, accumulating at va- 
rious points along and behind the trenches piles of 
brushwood, straw, or other inflammable trash, sprin- 
kled with petroleum, not unlike the smoke-pots and 
smudge-heaps scattered about through the orchards 
of Southern California to be lighted to protect the 
oranges against frost. 

Whenever a gas-cloud is launched, all these quick- 
burning piles down the wind from it are lighted, and 
the result is a swift, upward-rushing current of hot 
air which catches the gas and carries it into the upper 
layers of the atmosphere, at the same time neu- 
tralizing it by the gases and fragments of organic 
matter in the smoke. This is quite an effective pro-, 
tection when skillfully carried out, and the French 
Surgeon-General with whom I visited assured me 
that in regions where gas was frequently used even 
the animals came to know the meaning of it, and 
horses, dogs, mules, and cats rushed to and crowded 



184 THE DOCTOR IN WAR 

round the fires — having no gas-masks, poor beasts. 
They were led to the fires for safety in the first place 
by the men who had them in charge, but after a few 
experiences all that was needed was to turn them loose 
and they would rush eagerly to these safety spots. 

I found quite an ingenious device adopted in the 
Italian Army on this same principle — sticking little 
hedges or rings of short, cone-shaped torches, soaked 
with petroleum, across the front of all gun batteries 
and gun emplacements below the level of the ground. 
These torches are provided with a fulminate so that 
whenever a gas-shell explodes anywhere near them 
they "go off" and burst into flames, thus carrying 
up the gas-fumes and preventing them from pouring 
down into the gun-pits. 

The second type of war gases, the lachrymators 
("weepers") or "tear-gas" shells, can be quickly 
dismissed. As their names imply, they are vapors, 
which are not actively poisonous or strong enough to 
burn or blister the skin, but are intensely irritating 
to the eyes, producing such profuse and uncontrol- 
lable floods of tears that the soldier for some minutes, 
or even an hour or more, is practically completely 
blinded by them, and of course for the time being is 
of very little use for fighting purposes. 

In the beginning the chief German "tear-gas'* was 
made from the seeds of a tropical grass known as 
"sabadilla," and discovered by the extreme annoy- 



THE STRANGLERS 185 

ance which it caused to laborers clearing the Central 
American jungle for rubber or cocoa plantations. 
It transpired that Germany had been importing 
these seeds by the ton for years past, for what pur- 
pose no one could guess until the war broke out! 

Of course, as soon as German commerce was swept 
from the seas by the English Navy, this source of 
"tear-gas" was cut off, and they have since been 
using an intensely " oniony* ' synthetic compound 
known as xylyl bromide. And another whose name 
is utterly incapable of pronunciation, except that it 
has a "form" in it, which gives a formalin clue to 
one secret of its weepiness. 

These "tear-gases" are always fired in shells, and 
while, as one authority expresses it, they have added 
somewhat to the discomforts of an already uncom- 
fortable war, they have not proved of any great 
practical value. It is reported that one or two small 
detachments, surprised by them when they were first 
used, were attacked and captured while temporarily 
blinded, but the troops were quickly provided with 
goggles whose rims were backed with spongy rubber 
cushions, fitting air-tight to the face, and completely 
protecting against the "weepers." 

The last group of the gases, the irritants or blis- 
terers, while fortunately not dangerous to either life 
or eyesight if the mask is worn, are the most prac- 
tically troublesome and annoying of the whole lot, 



186 THE DOCTOR IN WAR 

and far the most heavily used. It is estimated that 
in some of the recent preliminary bombardments, 
from a third to a half of the shells fired of all descrip- 
tions, were gas-shells or mustard-gas. 

This last is the gas masterpiece of the General 
Staff and is a peculiarly German vapor, being sneaky 
because it is invisible and almost odorless, murderous 
to the wounded because it will hang about for days 
or even weeks in shell-holes or abandoned dug-outs 
just waiting for them to fall into it, and peculiarly 
vicious and painful in its attack upon the skin of the 
body, which it burns like liquid fire or scalding steam. 
It has nothing to do with mustard, but is a syn- 
thetic or specially constructed compound known in 
chemical circles as chloro-ethyl sulphide. 

The only warning given by this gas is a faint mus- 
tard-like smell and a slightly sweetish, pungent taste 
in the mouth, instantly recognized by those who 
have once experienced it. In the beginning it caused 
quite a number of deaths because the troops, not 
being familiar with the odor, did not put on their 
gas-masks until it was too late, and when you breathe 
mustard gas deep into your lungs the consequences 
are much the same as when you breathe in flame in 
a burning building. It literally burns the linings out 
of your bronchial tubes and you have about a fifty- 
fifty chance of dying of septic pneumonia a week or 
ten days later. 



THE STRANGLERS 187 

I happened to see scores of these mustard-gas pneu- 
monia cases in the Allied Base Hospitals, last au- 
tumn, when the beastly stuff was first used, and hun- 
dreds of the skin burns, and they were a pitiful sight. 
One great group of hospitals alone had had five thou- 
sand cases and nearly one thousand deaths. The 
worse cases of all were those of wounded who had 
fallen into holes full of this treacherous gas and who 
had to lie there for hours, and of one half company 
of soldiers, who had gone back to their dug-out to 
rest, not knowing that it had been shelled and filled 
with mustard-gas in their absence. They actually 
lay down in their bunks and went to sleep without 
detecting the stuff, and woke up a couple of hours 
later, literally burning alive, both inside and out, and 
although they were able to struggle up to the surface 
and get taken to the hospital, over half of them died. 

But this was only in the surprise period, when the 
troops were unfamiliar with the engaging little pe- 
culiarities of mustard-gas, and the report was spread 
up and down the trenches that it would go right 
through the gas-masks. As soon as they were reas- 
sured that the mask was a complete protection to 
both lungs and eyes, and were warned of its lack of 
odor and its habit of lying in shell-holes and in dug- 
outs unless they were thoroughly fanned or sprayed 
out before being occupied, it ceased to be seriously 
dangerous. 



188 THE DOCTOR IN WAR 

At that time we could tell gas-shells from ordinary 
shells by the fact that they made but a feeble report, 
being loaded only with just enough explosive to 
scatter their poisonous cloud abroad through the air. 
So that the veteran soldier, as soon as he noticed that 
many of the shells in his neighborhood seemed to 
be "duds," or failed to explode properly, promptly 
suspected gas-shells and reached for his mask. But 
the German Gas Board quickly "caught on" and 
remedied that little defect by increasing the charge 
of explosive, so as to make a gas-shell as loud as an 
ordinary shell. Hence, the troops now, as soon as any 
serious bombardment commences, put on their gas- 
masks as a matter of routine. This, of course, does 
not protect them against the burning effect of the 
gas upon their bodies. But it has been found that, 
unless they are actually drenched with the gas — 
or, more accurately, sprayed, because mustard-gas is 
not a gas, but a liquid — by the bursting of a shell 
within twenty feet, or lie for some time in a shell- 
hole or trench-bay or dug-out, which is filled with 
the gas, it will not soak through their clothing in 
sufficient amounts to do much harm. 

If a mustard-shell bursts actually in a trench, its 
fumes can be fanned out by vigorous use of boards 
or paddles, or a sort of wicker fan provided for the 
purpose ; while I was assured that if a soldier gets 
his clothing saturated by the landing of a gas-shell 



THE STRANGLERS 189 

within twenty feet and begins to feel the "bite" of 
the gas on his skin, and can promptly throw off his 
clothing he will escape with only a few blisters. He 
has to count himself as a light casualty and go to the 
rear with the rest of the wounded, and if he does this 
promptly enough all will be well. His literal "dress- 
ing " will not take very long, and he will soon be back 
on the firing-line again. 

The gas cannot attack the surface of the body 
where it is dry, but only where the skin is moist from 
perspiration, as under the collar, round the hat-brim, 
under the arm-pits, etc. Bad as mustard-gas is, if 
a soldier puts on his gas-mask promptly and counts 
himself as a light casualty whenever a gas-shell 
explodes within twenty feet of him, he will side-step 
nine tenths of its dangers. Its one redeeming fea- 
ture is that the burns of the skin produced by it, 
though fierce and painful, are quite superficial, and 
although very slow in healing, because the gas seems 
to poison as well>as to burn, they leave no scars; and 
even the eyes which have been caught unprotected 
by goggles are not permanently damaged by it. As 
an illustration of the heavy, clinging character of 
this gas, nurses undressing wounded men whose 
clothing has been soaked with it will get their fin- 
gers burnt unless they wear rubber gloves. 

As for the treatment of gas-poisonings, far and 
away the best cure is prevention and the most po- 



\ 



190 THE DOCTOR TN WAR 

tent remedy is a little word of four letters, nt-a-s-k. 
By the prompt and vigilant use of the box-mask, not 
only the fatalities, but severe gassings have been 
cut down to only a few in a thousand of the troops 
attacked, for nearly two years past. It was in fact 
the perfection of the gas-mask and of the allied gas- 
drill and systems of warning that caused the German 
Staff practically to abandon the gas-clouds or gas- 
waves on the Western Front. 

The details of this drill have become literally a 
household word, since so many of us have boys of 
our own or friends in the training-camps. The young 
recruit is first trained in putting on the mask snugly 
and learning to breathe comfortably in it, first at 
rest, then walking, and finally running, drilling, 
working, and even playing football. Then comes the 
"gas-house," where he is dosed with first a mild, and 
later a strong, concentration of the gas so as to learn 
confidence in his mask. Finally, with his gas-mask 
in the "alert" position strung high across his chest, 
the alarm is sounded, followed thirty seconds later 
by the "wave." This sounds rather swift, but as the 
standard time for hustling into a gas-mask is ten 
seconds from the "alert" and fifteen from the 
"carry" position, and it has been known to be done 
in four, there is ample margin. 

Every possible precaution is taken, as both Eng- 
lish and French officers assured me that sergeants 



THE STRANGLERS 191 

and corporals have to keep the sharpest lookout upon 
the files as they first march into the literal " lethal 
chamber," for in every hundred youngsters there will 
nearly always be found one or two, who, in spite of 
all coaching and assurances, are smitten with panic 
and lose their heads completely at the first whiff of 
the chlorine and clutch wildly at their masks to tear 
them off, and only the promptest seizing and hustling 
instantly neck and crop out of doors will save them 
from serious strangling! And I don't mind confess- 
ing a deep sympathy with and for those poor, teriror- 
crazed young rookies. 

But supposing some accident had happened, that 
a man has been wounded before the alarm was 
sounded, or a shell fragment has torn his gas-mask; 
even then the chances are ten to one against any se- 
rious result. He is promptly seized by his comrades 
or the stretcher-bearers and an extra mask hustled 
over his head, or, if none is available, a heavy wet 
bandage is tied over his mouth and nose, and he is 
hurried with the wounded to the rear. 

The best remedy against chlorine and phosgene 
is another gas — oxygen — and all Casualty Clear- 
ing-Stations and Evacuation Hospitals, and many 
Advanced Dressing-Stations are equipped with a 
cylinder of oxygen with a multiple nozzle, so that 
eight or ten tubes can be attached to it, for the treat- 
ment of as many gas victims at once. 



192 THE DOCTOR IN WAR 

A gassed soldier is treated strictly as what the 
English call a "Her" and the French a "grand 
bless6" ("heap wounded"), and carried on a 
stretcher in spite of his indignant protestations that 
he is perfectly able to walk, because the great dan- 
ger from phosgene is death by heart failure during 
exertion an hour or so after the gassing. 

Officers who have flatly refused to leave the trenches 
have been known to fall dead while shouting com- 
mands to their men. But if the phosgene-gassed man 
is kept completely at rest for four or five hours, he 
is almost entirely safe from this disaster. Unless he is 
suffering a great deal of distress in breathing, it is 
considered safer to keep him in the first shelter where 
there is room for him to lie down comfortably, even 
at some little risk of shell-fire, rather than put him to 
the strain of being carried back to the Dressing- 
Station or Hospital where he can get oxygen. 

If much chlorine has been inhaled, nothing relieves 
the agonized gasping and struggling for breath like 
oxygen, and I have seen three and four patients at a 
time lying on cots around the blessed oxygen tank, 
each sucking away at a tube contentedly, as com- 
fortable as kittens, and on the highroad to recovery. 
In severe cases of gassing with chlorine, prompt 
bleeding — the old-fashioned blood-letting, or vene- 
section — often gives great relief, because it drains, 
as it were, the dreadful edema or watery swelling 



THE STRANGLERS 193 

of the tissues of the lungs, produced by chlorine gas, 
which is the chief cause of suffocation and death. 

This was very popular at one time in both the 
German and the French Army, but it has now been 
abandoned or only used where oxygen cannot be had, 
because it does not relieve any more rapidly than 
oxygen does, and has no curative effect at all, the 
distress coming back again in the course of an hour 
or two. Another extremely prompt and effective 
remedy, which is at present a military secret, has 
recently been worked out by our own American Gas 
Investigation Board at New Haven. 

Altogether, what with rest, oxygen, and blood- 
letting in dire emergencies, the death-rate from gas 
poisoning has been cut down to less than ten per 
cent — in some hospitals that I visited to less than 
five per cent. So that the word "gassed" no longer 
fills us with the sense of helpless and hopeless horror 
which the sight of those first green-face specters of 
men, gasping and frothing at the mouth in mortal 
agony in the earlier gas-clouds, had indelibly im- 
pressed upon our minds. 

My most courteous guide and conductor through 
the front-line hospitals of one of the English armies 
happened to be the surgeon into whose Dressing- 
Station behind Ypres were carried some forty of the 
victims of the first gas-attack. And he said that never 
until his dying day could he forget that scene, the 



194 THE DOCTOR IN WAR 

distorted countenances and sobbing agony of the 
poor fellows, and his own utter sense of helplessness 
to do anything to relieve them. 

Fortunately, however, those dreadful scenes did 
not last long, and since the introduction of the mask, 
I have not been able to find any hospital along the 
whole of both the British and French Fronts which 
had had a mortality of more than twenty per cent 
Jn its gas cases even before the use of oxygen. 

But what of those who recover from gassing? How 
permanently are they damaged and what is their 
future outlook? Here again I was agreeably sur- 
prised, because I had heard many and widespread 
rumors, not only among the public, but in the medi- 
cal profession, to the effect that any man who had 
once been badly gassed was practically ruined for 
life and never fit for active duty again. On the con- 
trary, I found that the great majority, probably at 
least seventy per cent, including, of course, the 
lighter cases, recovered as completely as they would 
have done from an ordinary pneumonia or a bron- 
chitis, and were back again on the firing-line, appar- 
ently as well as ever, in a month or six weeks. 

A considerable minority, however, perhaps a fifth, 
were left in a wheezy, asthmatic, chronic broncKitic 
condition which lasted for several months, and in 
some cases a year or more, and which temporarily 
unfitted them for active service, but even most of 



THE STRANGLERS 195 

these seemed to clear up finally and recover almost 
completely. A small number seemed to be rendered 
permanently asthmatic, particularly among men 
over forty. 

As to the widespread popular belief that gassing 
was peculiarly liable to be followed by tuberculosis, 
and that we should need large hospitals for the ac- 
commodation of the consumptive soldiers rendered 
tubercular by gas, I could find no foundation for it, 
even after visiting not merely the Field and Base 
Hospitals, but a number of the special sanatoria and 
hospitals for consumptive soldiers in both France 
and Italy; except that in about a dozen cases, men 
who were known to have been tuberculous before 
they entered the army, and had the disease in a rest- 
ing stage, suffered a relapse after being gassed. 

It is, of course, too early to speak positively about 
two such extremely chronic diseases as consumption 
and bronchial asthma, but so far apparently not more 
than one or two per cent of those gassed have de- 
veloped either of these diseases. 

For mustard-gas, if inhaled deeply and long enough, 
there is no effective treatment, because no known 
drug will supply the bronchial tubes and air pas- 
sages with new linings to take the place of the old 
ones which have been literally burnt out. But one 
half to two thirds even of these cases fight their way 
through to recovery from their septic pneumonia, 



196 THE DOCTOR IN WAR 

and they are now quite few in number, since the 
troops have learned to put on their gas-masks at the 
first suspicion of gas-shells in a bombardment. 

Altogether, what with the box-masks, gas-drills, a 
perfect system of gas-alarms by means of great Strom- 
bos horns driven by compressed air, fans and paddles 
of various sorts for driving the gas out of the trenches, 
and the Vermorel anti-gasspray, which cleans the air 
of trenches and dug-outs by precipitating chlorine 
with a chemical spray, the percentage of deaths, or 
of even serious poisonings or burnings, by gas has been 
reduced to a very small one. The great German gas 
drive has been completely checked, if not actually 
checkmated. 



XI 

THE DRINKING-WATER OF THE SOLDIER 

WATER, in spite of its proverbial " weakness* ' 
and instability, is one of the chief sinews of 
war, not only in the fundamental sense that every- 
thing about us which is really alive swims under 
water, and dryness spells death — ■" dusty death " 
as Macbeth calls it — but also from three purely 
military and local points of view: First, the soldier 
needs water to fight on — a regiment in action with- 
out water becomes useless almost as quickly as one 
without:, ammunition. Second, because the wounded 
are desperately in need of water, on account of the 
drainage of their bodies by loss of blood. Hence, the 
apparent paradox that the wounded who have to 
lie out on the field in rain and even in snow suffer 
far less and keep in better condition than those who 
fall in dry hot weather. Numerous instances are on 
record in this war of men who have fallen wounded 
in some remote or hidden shell-crater and have lain 
there in rain, sleet, and even snow for from five to 
seven days, and have then been picked up not merely 
alive, but in condition to make a rapid recovery. 
A man will stand a lot of cold and a lot of soaking, 
but he bears drying very badly. One instance re- 



198 THE DOCTOR IN WAR 

lated to me by a surgeon friend to whose hospital 
the wounded man was brought establishes a new- 
world's record in human endurance. He had lain out 
in a shell-hole in No Man's Land, or rather behind 
the first German line, for fifty-one days in wet weather 
with a shattered leg, drinking the rain water which 
pooled in the shell-hole and living on the " iron ra- 
tions " in the knapsacks of the dead bodies around it 
within the area over which he could drag himself on 
his hands and one knee during the nights ! Thirdly, 
because water is one of the chief means of convey- 
ance and spread of the three great camp plagues or 
army fevers, typhoid, cholera, and dysentery. These 
three plagues in historic times followed the colors as 
surely as the vultures did, because the very first thing 
which an army without modern first-class sanitary 
service does in the field is to foul its own water- 
supply. 

Kipling has vividly expressed the vital necessity 
of water to the fighting man in his famous ballad 
of "GungaDin": — 

" You may talk of gin an* beer, w'en you're quartered safe 

back here, 
With your little penny fights and Aldershot it, 
W'en it comes to bloody slaughter, you will do your work 

on water, 
An' you '11 lick the bloomin' boots of 'im that 's got it." 

The water-supply for an army in the field is an ex- 
tremely difficult and perplexing problem, as vexing 



DRINKING-WATER 199 

as it is vital. It was on account of its desperate and 
apparently hopeless struggles with the problems of 
water-supply, or, what is simply another way of put- 
ting it, sewage-disposal, that sanitation came to be 
regarded as one of the dismal sciences. 
; Even leaving out of count altogether such trivial 
details as purity and wholesomeness, it is often under 
modern war conditions difficult to get a sufficient 
amount of just plain wetness for an army or a unit. 
This at first sight seems incredible, because there 
appear to be rivers and streams almost everywhere 
rambling over the face of the planet, and where there 
are no rivers there are ponds and wells. 

But unfortunately modern armies have to live 
along or near trenches, and trenches cannot always 
be dug in river valleys; in fact, they very seldom 
can, on account of difficulties of drainage and flood- 
ing; hence the Front usually runs along the tops of 
ridges. Along those ridges there may be scattered 
a few villages, each with its wells or springs, and be- 
tween them an occasional well or dew pond. 

But when you remember that the soldier popula- 
tion of the Western Front is over ten thousand to the 
mile, then the trifling supply sufficient for the rural 
population becomes a mere drop in the bucket. Es- 
pecially in view of the fact that that rural popula- 
tion never drinks water when it can possibly help it, 
and considers itself punctilious to the verge of ab- 



200 THE DOCTOR IN WAR 

surdity if it takes a bath once a year. This is no 
mere figure of speech; there are scores of old men in 
these villages who cannot remember the date of their 
last bath, and I have seen a copy of a prospectus of 
a famous boys' school, about thirty years ago, in 
one of the chief Continental cities, in which a full 
section is devoted to the proud announcement that 
parents may feel confident that the health of then- 
children will be most strictly guarded, for they will 
receive regularly one foot-bath each week and one 
full bath (" grand bain") each month! 

In mountainous regions like most of the Italian 
Front, and particularly the Carso, all the water for 
the troops, not only in the trenches, but also in the 
support and part of the reserve lines, has to be hauled 
from two to five miles in tanks or water-carts or 
huge casks, and if the Austrian gunners can succeed 
in spotting the row of casks or concrete tank in which 
the water-supply for the first-line is stored upon the 
top of the mountain, and drop a batch of shells into 
it, they are as pleased as if they had blown up an 
ammunition dump. 

Even along such moderate elevations as the ridges 
of the Somme, my Army doctor friends have assured 
me that both armies have found it a matter of great 
difficulty and watchfulness to secure an adequate 
supply of water for the armies of the first and second 
lines. 



DRINKING-WATER 201 

In some cases it has been necessary to go to the 
trouble and expense of laying pipe-lines from some 
mountain lake or stream above danger of con- 
tamination, or deep wells, three to six miles away, 
just as if one were supplying a city. Several of the 
sections of both the English and the Italian Fronts 
have been supplied in this way and given an abund- 
ance of pure cold water which needs neither filtering, 
boiling, nor chlorinating, which is an unspeakable 
boon in war-time. 

The majority of army areas, however, have to draw 
their supplies from some river or lake or pond. Now, 
a river is a lovely thing to look at, "composes" beau- 
tifully in a picture, is delightful to boat or canoe on, 
refreshing — sometimes — to swim in, but to drink 
out of — ! Rivers would be all right for drinking- 
water if it were not for the habit which villages have 
of coming down and roosting on their banks. We have 
all heard of the pious citation in proof of the bene- 
ficent and guiding interest of Providence in human af- 
fairs, in that great rivers always run by large towns 
even if they have to go miles out of their way to do 
it: which, from a sanitary point of view, is very nice 
for the towns, but very bad for the rivers. In short, 
a running stream in anything like a thickly settled 
or civilized country is little better than a common 
sewer. And wells dug along its banks or in the bot- 
tom lands of its valley are little better. It is almost 



202 THE DOCTOR IN WAR 

incredible to any one, who has not made a special 
study of water-supplies, how swift and certain is this 
contamination of wells, ponds, and rivers. 

Our American Army camps in the foothills and 
plateaus of the Rocky Mountains region used to be 
greatly troubled with a serious fever known as moun- 
tain fever. It had many of the characteristics of 
typhoid, including a fairly high death-rate, but every- 
body scouted the idea of water-pollution in those 
wild, clean mountain ranges. But one or two out- 
breaks were clearly traced by Army surgeons of an 
inquiring turn of mind to contamination by Indian 
encampments farther up; the water was boiled or 
chlorinated and the disease disappeared. 

A more modern instance was furnished in amusing 
fashion only a few weeks ago on the Western Front. 
A division of our Allied troops was billeted in a cer- 
tain village. They built their sinks and latrines ac- 
cording to sanitary regulations, and ran them into 
deep pits dug in the soil, of the cesspool type, and to 
discourage flies treated them daily with a disinfectant 
solution containing creosote. Within three or four 
days the village fathers waited upon the command- 
ing ofhcer with the bitter complaint that the creosote 
was utterly ruining the taste of the drinking-water- 
in their favorite wells! They had become quite ac- 
customed to and unconscious of the taste of sewage, 
but the flavor of creosote was more than they could 
stand. 



DRINKING-WATER 203 

While the purification of water in the field by 
chlorine is simplicity itself — just dip up the water, 
add the chlorine, shake, and allow to settle — its 
carrying-out on any considerable scale in the field 
requires a little apparatus. The question of the 
proper proportions of chlorine is readily met by the 
provision of boxes or cases of glass tubes each con- 
taining enough bleaching powder to sterilize safely 
five gallons, ten gallons, or twenty gallons of water, 
as may be needed. 

Then comes the question of a container for the 
water, for, although it is quite possible to sterilize 
it by the pitcherful or the bucketful — in fact gallon 
and even quart tubes are provided for the use of 
travelers or small parties — in camps, of course, it is 
advisable to treat sufficient for a day's supply at once. 

For work in the open field and temporary camps, 
the container used by the United States Army is 
simplest, cheapest, and most easily portable. This 
consists of a stout, waterproof canvas bag capable 
of holding thirty gallons, with three nickel-plated 
spring-action faucets opening from its lower part, 
and three stout, white-metal rings set round its 
upper border or mouth. This is slung on a tripod of 
poles by cords from the rings, at such a height as to 
bring the faucets about four feet above the ground, 
has a canvas flap or cover, and will supply drinking- 
water for the night and morning for a hundred men. 



204 THE DOCTOR IN WAR 

It takes only a few minutes to fill and sling, and 
thirty minutes later there is an abundant supply of 
pure drinking-water, without unpleasant taste, in 
an extremely accessible and convenient form. When 
the bag is empty, it collapses, and can be folded with 
its ropes into a small, compact bundle, so that it is 
admirably adapted for cavalry campaigning and one- 
night camps. 

The next simplest method, and the one most com- 
monly in use on the Italian and French Fronts, is 
that of a couple of large casks, or, where circum- 
stances permit, of specially constructed tanks placed 
side by side. Into one of these the raw water is 
pumped from the stream or pond or well, treated 
with the bleaching powder, stirred well, and allowed 
to settle. When all the sediment has subsided, the 
water is siphoned over into the other tank or cask, 
from which it is drawn directly for use or piped over 
the camp. 

Where it is possible to use a permanent supply of 
water with a system of distributing-pipes, the chlori- 
nation is quite simple; all that is needed being an 
additional basin just before the water goes into its 
permanent storage or distribution reservoir, in which 
the water can be held for an hour while the proper 
-proportion of bleaching powder is added to it. 

Indeed, it may be of interest to remark incidentally, 
especially as the fact is not generally known, that 



DRINKING-WATER 205 

so perfect is the protection afforded by bleaching 
powder, and so many and incalculable are the dan- 
gers which threaten a great city's water-supply, that 
many of our large American cities — New York, 
Chicago, Cleveland, and Toronto, for instance — 
chlorinate their water before passing it into the mains. 
So that many who read this know by practical ex- 
perience how completely free from disagreeable taste 
properly chlorinated water is. 

It is on the English Front that the most thorough 
and carefully thought-out system of water-supply 
for the troops is in operation, though that of some 
sections of the Italian Front, which have piped in 
water from an available mountain stream, is extremely 
good. In a very considerable number of the English 
Army areas, they have either cleaned out and uti- 
lized old reservoirs or constructed new ones, and laid 
regular water-mains down behind their lines, with 
branch pipe-systems to supply the different camps. 

Some of these reservoirs are filled by pumping 
from a stream or lake, or large marshy pool preserved 
for duck-shooting purposes, known by the French 
as an "6tang, M and then filtering and chlorinating the 
water. Some of this water is piped from quite a con- 
siderable distance, of which I had a rather amusing 
illustration at one point on the English lines "some- 
where in France." The Chief Sanitary Inspector for 
the Army area, a most enthusiastic and competent 



206 THE DOCTOR IN WAR 

Staff officer who was courteously showing me the 
sanitary arrangements of the zone, informed me 
with a chuckle of natural pride that the water-supply 
of something like three divisions of the British Army 
was being drawn from a small lake a mile or more 
inside the German lines, which was rather a good 
joke on Fritz and his wonderful, superhumanly om- 
niscient spy system. 

My friend the Major said that it only balanced up 
matters, anyway, because the Germans had care- 
fully selected the high ground for their trenches in 
such a way that they were not only able to drain 
them completely without pumping, but to pour 
their drainage into the English trenches on the 
lower ground: which was certainly adding insult to 
injury. Needless to say, the water from this conduit 
was thoroughly sterilized and filtered, as well as 
frequently examined for possible poisoning. 

Incidentally, as a specimen of the spirit with which 
sanitary measures are carried out in the English 
Army, this same Inspector, after a great battle and 
an advance of nearly three miles, had drinking-water 
piped on to the battle-field itself for the use of the 
thirsty troops within five hours of the time that they 
had established themselves in their new positions! 
I strongly suspect (though upon that point I have no 
positive information) that he utilized this secret 
conduit by tapping it higher up toward its source, 



DRINKING-WATER 207 

but even that would involve the laying of something 
like a mile and a half of pipes over an extremely- 
broken and irregular surface, and certainly does not 
detract in any way from the remarkable credit of 
the performance. 

Where circumstances do not permit of the install- 
ing of a pipe supply of water, the English sanitarians 
have devised one of the most perfect machines for 
transforming any kind of water into a clear, safe, 
drinkable beverage that I have ever seen. It is based 
upon the chlorination method, and consists of a group 
of tanks with an engine and purifying system mounted 
upon a large motor truck. The engine of the truck 
provides the necessary power and heat. 

The machine pumps its own water from a stream 
or well or pond, drives it through a mechanical filter 
under pressure, precipitates it with iron alum, and 
again filters it under pressure, thus removing en- 
tirely all visible impurities. Then it passes it into a 
large tank where the chlorine solution is injected into 
it, and after a brief period of delay, the now pure, clear, 
and absolutely sterile water passes out through the dis- 
charge pipes, into casks, reservoirs, or temporary pipe- 
lines. By an ingenious arrangement of tubes with glass 
"windows" or eyelets in them, samples of the water 
are brought right under the eye of the operating 
engineer in the cab of the motor at every stage of the 
process, and by stop-cocks specimens are drawn off 



208 THE DOCTOR IN WAR 

and tested, first chemically and at the last bacteri- 
ologically, so as to see that the process is working to 
perfection at every stage. 

An equally ingenious series of stops and valves 
gives the engineer perfect control of the different 
chemical and sterilizing processes, so that he can in- 
crease or diminish the amount of precipitant (alum), 
the pressure of the filter, and the proportion of 
chlorine, merely by the pressure of a finger. 

The result is so absolutely perfect as to give one 
almost an uncanny sense of magic. The first ma- 
chine which I saw was doing a special "stunt" test. 
It had dropped its intake pipe into a pool of filthy, 
pea-soup-colored, stagnant water, covered with green 
scum which had collected between two refuse heaps 
at the back of an abandoned factory. From its dis- 
charge pipe was flowing into a large tank a steady 
stream of clear, sparkling, nice-tasting water. To 
look at the water in the filthy pool and the clear 
stream rushing and sparkling into the tank, gave 
one a positive shock. 

The motor weighs about three and a half tons, 
travels by its own power anywhere, can get under 
way inside of thirty minutes, and can transform the 
vilest soup into pure drinking-water at the rate of 
about a thousand gallons an hour. That is to say, 
one machine is capable of supplying an army of ten 
thousand men. 



XII 

GUARDING THE HEALTH OF OUR FIRST 
AMERICAN TROOPS IN FRANCE 

A MORE quietly charming and peacefully pictur- 
esque country than that in which our American 
Expeditionary Force was first temporarily quartered 
could hardly be imagined: a gently rolling country 
of hill and valley, rising gradually in long, broad- 
crested waves to join the western mountains; the 
tops of the ridges for the most part bare, thinly 
covered with soil bearing dwarf scrub or wiry grass. 

The towns and villages lie sheltered in the valleys 
on the rich but narrow green bottom lands along the 
swift streams. The slopes leading up to the long, bare 
hill ridges, and the deep little cross- valleys running 
down from them, are clothed with woods. The effect 
is quaintly picturesque and ribbon-like, as if some 
skilled gardener had laid out the country in broad, 
contrasting bands: a narrow band of bright green 
down the bottoms of the valleys, picked out with red 
roof and gray wall and silver gleams of river; a broad 
band of dusky green of trees and copses along the 
slopes; and another band of gray and silver green 
along the bare half-alpine tops of the ridges. 

To make the gay formal garden effect more com- 



210 THE DOCTOR IN WAR 

plete, the moors above are splashed with purple 
streaks of heather, and the stubbles below are one 
blush of pink, from sheets of a magenta-flowered 
mint. 

It is a land of sheep and cattle and bees, and closely 
resembles the Joan of Arc country. In fact, that beau- 
tiful pitch upon the shoulder of the hill, with the 
wheat-fields and pastures sweeping away below it 
and the green shadows of the woods behind, where 
the Maid saw her first vision and the memorial church 
is built at Domremy, stands on the slopes of just 
such a valley as is repeated a dozen times in our 
America in France. 

The Maid is gone, and her visions have come true 
beyond her wildest dreams, but her sheep still re- 
main unchanged. You can see them being driven 
down by scores and hundreds in the sunset light 
every evening, by the same old sheep paths and wind- 
ing lanes, from the moorland pastures above to their 
folds under the same roof as their shepherd in the 
village below. And their shepherds look ancient and 
time-worn and primitive enough to have known 
"La Pucelle ,, when she was an infant in arms. 

History repeats itself in a rather unexpected way 
sometimes, and our troops almost precisely duplicate 
the movements of the Maid and her sheep, as they 
march up to the moorland levels every morning, 
only to train and drill instead of cropping grass and 



OUR FIRST TROOPS IN FRANCE 211 

seeing visions. The fields at the bottom of the val- 
ley are too narrow and crowded and the land too 
valuable to be torn up with trenches and covered 
with barbed- wire entanglements. So most of our 
regiments march up the hill slopes for a mile and a 
half to three miles every morning — which is very 
good for their wind — to their training fields and 
drill trenches, which have been laid out along the 
broad, rolling summits of the ridges. 

Here they march and countermarch and practice 
complicated maneuvers of attack, charge with the 
bayonet, jab viciously downward at dummy Ger- 
mans in the first trench as they leap over it, and jump 
fiercely down into the second one and proceed to 
1 'mop up" imaginary Boches. This, with rifle and 
machine-gun practice on the ranges, with sham fights 
against the splendid veteran " Chasseurs a pied " and 
other French troops which have been sent down to 
drill with and against them, fills up the time busily 
until the clatter and groaning of the chuck wagons 
scrambling up with their mule teams from the valley 
below announce the hour of grub. 

Each man draws his mess-tin and dipperful, and 
the squads squat down in long rows on the ground, 
officers and men alike, and fall to eagerly. Then, 
after twenty minutes of luxurious basking with 
slackened belts, the bugles sound, up they get, and 
at it again vigorously for two more hours, and then 



212 THE DOCTOR IN WAR 

line up for the march downhill and into billets in the 
village below. 

It is a busy, vigorous, happy life in the open air 
and the men take to it like ducks to water. And there 
is a good deal of water for them to take to, for their 
first "baptism of fire" was three weeks of almost in- 
cessant, chilly, pelting autumn rain, which falling on 
a clay-loam soil gave them a real foretaste of the 
famous mud of the trenches. But this did not stop 
or dash them in the slightest — they drilled and 
marched, and charged with the bayonet and counter- 
attacked, and jumped down into trenches half full 
of muddy water, all in the pouring rain, until they 
got so hard and " self-heating " that they positively 
enjoyed the downpour — or, at least, they said so. 

The men are fairly bursting the buttons off their 
tunics, not below the waist, but across the chest, and 
not a few of them can actually hardly get into coats 
which were a comfortable fit when they joined the 
Army three months ago. They are getting as hard as 
nails and as waterproof as trout. And so splendidly 
are they fed and so superbly sanitated and protected 
against diseases of all sorts, that their sickness rate 
is barely one and three tenths per cent, as compared 
with two and a half in barracks in time of peace. 

The first and most vital problem — that of the 
food-supply — has been solved by the company or 
double company messes with their camp-stoves and 



OUR FIRST TROOPS IN FRANCE 213 

< 

semi-underground ovens under the big mess-tents 
which are pitched at convenient corners or open 
spaces along the village streets, with the mess- tables 
alongside under similar awnings or out in the open. 

Many of the men take their mess-tins and panni- 
kins full and find seats for themselves on carts and 
baskets and doorsteps and the platform in front of 
the Mairie and eat their rations picnic-fashion. This 
forms a great source of interest and amusement for the 
small fry of the village, who have an intense curi- 
osity about the new and strange food of these huge, 
friendly, good-natured allies of theirs, particularly 
the corn-syrup and the dried-fruit pies and the dough- 
nuts and the chocolate. Though they tasted them in 
fear and trembling at first, they now highly approve 
of these novelties. And although the natural polite- 
ness and good manners of all French children will not 
allow the older ones to "hang round" at meal-times, 
except by special invitation from personal friends 
to whom they have been properly introduced, the 
toddlers and three- and four-year-olds have no such 
false delicacy. 

It is a pretty sight to see a great strapping young 
six-footer from Texas, with a plump, round-eyed 
youngster perched on his knee, sampling eagerly 
each of the successive " courses." With the older 
children the language question presents some diffi- 
culties, though they make the very best of teachers, 



214 THE DOCTOR IN WAR 

so that that quickly disappears, but with the younger 
ones the universal sign language and lip-reading are 
quite sufficient. 

I was greatly amused by one roly-poly youngster, 
pretty nearly as broad as he was high, who sat on 
the pavement, with his short fat legs sticking straight 
out in front of him, right alongside of his soldier 
friend. He did not waste a single word or sound or 
motion while I was watching him, but whenever he 
needed a fresh supply, he simply tipped up his beak 
and opened it wide, like a young robin in the nest. 
The moment he was loaded he closed it again and as 
soon as the gangway was cleared, repeated the pro- 
cess, without the loss of a moment or a breath. 

Nowhere upon all the various fronts which I have 
visited did I find children and soldiers on such friendly 
and intimate terms. In every village that our mili- 
tary auto passed through the children would line up 
and salute, and every group that we passed on the 
road would wave their hands to us and seemed per- 
fectly delighted when we saluted in return. This is 
due in part, I think, to the natural kindliness and 
fondness of children of our American boys, and in part 
to their homesickness. Grown-ups may differ in all 
sorts of degrees, language, dress, appearance, behav- 
ior, but children, thank Heaven, are alike the world 
orer, and seem like a little bit of home to every 
wanderer. 



OUR FIRST TROOPS IN FRANCE 215 

Wherever you go in the American Army area — 
whether you wear uniform or only just look like 
an American — you are saluted on every hand and 
greeted with bows and smiles of the most genuine 
friendliness. They make you feel that they think 
the mere fact that you are an American insures that 
you are a friendly, generous, and trustworthy sort 
of person, and it will be worth a lot of trouble on our 
part to live up to that reputation. If it had been 
carried out by orders from Headquarters from mo- 
tives of deepest laid diplomacy, it could not have 
been happier in its results. The same cordial respect 
and liking exists along the English Front, but it is 
not shown quite so openly on account of the wider 
differences between the French and the English tem- 
peraments. If an Englishman likes you, he is more 
than half ashamed to let you suspect it, and nothing 
embarrasses him more keenly than any open mani- 
festation of regard on your part. This utterly puzzles 
the French, who were even a little chilled at first by 
the triste and serious expression of our American sol- 
diers. But it did not take them long to get past that 
barrier, and within a few days they were on the 
very best of terms. 

In the language of the day, our American troops 
have "made a hit," and a most emphatic one, with 
all ages, sexes, and sorts of the French people. 

But this picturesque, picnic style of commissariat 



216 THE DOCTOR IN WAR 

for the troops will not last much longer. Proper mov- 
able kitchens, great boilers and ovens and cooking- 
ranges combined, mounted on wheels and drawn by 
horses or motors, have been adopted by the Army 
Board of Washington and will be supplied to the 
troops in due time. These wheeled army kitchens, 
called by the Germans "goulash-cannonen" and by 
the French "mitrailleuses a la batata," are extremely 
popular with the other armies, and are the literal 
cook-shop on wheels, with balancing and anti-splash 
arrangements which allow dinners to be cooked en 
route for regiments on the march. So that whenever 
the halt is called, the tired men find piping hot stews 
and potatoes and coffee all ready for them. 

On the busy roads up near the Front, when you 
meet a relief regiment changing posts, after the long 
files of blue-coated and blue-helmeted "Chasseurs 
a pied" or "Alpins" have poured past, come the 
transport wagons by the score, piles of bedding and 
blankets and kit, and then nobly protecting the rear 
roll the great "goulash-cannonen," with smoke pour- 
ing out of their chimneys and a most appetizing 
odor of savory stew floating up from the tops of their 
cauldrons. 

They are the stomach-warmers of the army, and 
the stomach lies very close to the heart. When camp 
is reached, they are halted in a convenient spot, a 
ridge-pole is run up over them, a big tarpaulin 



OUR FIRST TROOPS IN FRANCE 217 

stretched over that, and there you have a dry, warm, 
comfortable kitchen ready to cook anything that 
can be cooked in any hotel or restaurant in the land. 

When these have been installed in the villages 
and lumber to build comfortable mess-halls secured, 
which the men can dine in during the day and read 
and write letters and smoke in at night, — for neither 
lights nor smoking can be allowed in billets, — the 
army will be provisioned for any length or kind of 
campaign. 

The water problem has been solved by the use of the 
canvas thirty-gallon bags suspended on tripods which 
are to be seen dotted about every encampment. 
They, however, are only suited for the autumn 
maneuvers or Indian-chasing style of war, and will 
soon be replaced by proper double tanks or modern 
motor pumps and sterilizers combined, of the English 
fashion. 

The bags are portable and quickly set up, but for 
permanent use they have the very serious drawback 
of having the drinking-water drawn from the same 
vessel in which it was chlorinated. As there is no 
telling by the look of the water whether chlorination 
is complete or not, this means that unless some or- 
derly stands guard over the bag from the time the 
bleaching powder is put in until the chlorine has 
been completely neutralized, the first man who comes 
up to take a drink out of it will get a mouthful of 



218 THE DOCTOR IN WAR 

bleaching powder plus any dregs and sediment which 
may have settled to the bottom in the process. 
Which gives him a strong prejudice against any sort 
of chlorinated or otherwise " doped' ' drinking-water 
for the rest of that campaign. He will drink from any 
pump or well or stream that he can come across 
sooner than resort again to that "chemical" bag. 

While water which has been treated with bleaching 
powder is usually quite tasteless and good to drink, 
in from three quarters of an hour to an hour, it is 
much better and safer to let it stand overnight. So 
that all permanent plants for the chlorination of 
drinking-water consist of two tanks or large casks 
side by side, in order that the water may be treated 
and allowed to settle completely in the one, and then 
siphoned over into the other for use, leaving six 
inches of water and all the dregs in the bottom of the 
first container. 

Unless this is done, it is difficult to get the wary 
and suspicious dough-boy into the habit of drinking 
" bleached " water. Our Army medical officers are so 
zealous and vigilant that they succeeded in making 
the soldier-boys take most of their uncooked fluid 
nutriment from the bleaching bags, as is evidenced 
by the almost complete absence of diarrhoea and 
other intestinal disturbances in the camps. And as 
nine tenths of all the specimens of water from wells, 
fountains, or streams examined in the zone have been 



OUR FIRST TROOPS IN FRANCE 219 

found heavily loaded with colon bacilli, which means 
contamination with sewage, this is a real triumph for 
their enthusiasm and efficiency. 

But it is a constant and wearing strain upon their 
vigilance, which is unnecessary and might be en- 
tirely avoided by the installation of proper tanks 
and pipe-lines supplying each barrack in the camps. 
So direct and striking is the contamination of most 
of the native drinking-water in the army zone, that 
disinfectants used in our latrines give a strong flavor 
of creosote within a few days to all the wells and 
fountains in their neighborhood. 
j The third great sanitary requisite for the health 
of an army, latrines and sewage disposal, presents 
the greatest difficulties in the way of its solution. 
As none of the villages occupied by our troops has any 
pipe-line system of water-supply, the only methods 
of waste disposal possible are by the simple pit or 
trench latrines and the running of sewage water in 
open ditches directly into the streams. 

The soil of the valleys in which the villages lie is 
simply underlain with sheets of water, so that wastes 
disposed of in pits in the soil promptly find their 
way into all the other deeper pits called wells within 
a hundred or a hundred and fifty yards around them. 
This makes the pit or trench type of latrine distinctly 
undesirable from every point of view. 

The Sanitary Corps of the Army is keenly alive 



220 THE DOCTOR IN WAR 

to the difficulties of the situation in which it finds it- 
self, and the pail and incinerator system of the Italian 
and English camps has been applied for to the au- 
thorities and will probably soon be granted. 

In this method, the wastes in the latrines are 
kept entirely above ground in large pails containing 
small quantities of disinfectant fluid. These are emp- 
tied twice a day directly into a special type of 
incinerator, in which, by a skillful arrangement of 
draughts, they can be burnt completely without 
either smoke or odor, at an expense of only about one 
hundred pounds of coal per day for each five hundred 
men. 

This is the ideal method of camp sanitation, for it 
protects the soil from any kind of contamination, 
and what is even more important practically, it ab- 
solutely prevents that busy middleman of the pes- 
tilences, the fly, from carrying infection from one 
case to another. Every other known system for the 
disposal of wastes simply means their reappearance 
in somebody else's food or drinking-water sooner or 
later. Pails and the materials for building the in- 
cinerators have been promised, and this admirable 
system will doubtless soon be installed in our Army 
camps. 

The fourth and last great sanitary requirement, 
shelter, has been temporarily solved in our American 
Army zone by the use of billets. This means that the 



OUR FIRST TROOPS IN FRANCE 221 

men are housed in squads of from ten to twenty in 
barns, haylofts, granaries, stables, the second story 
of hen-roosts, and sheep-pens. After these have 
been thoroughly cleaned of the dust, cobwebs, and 
other deposits of past centuries, their entrances white- 
washed, and the inhabitants gently persuaded to re- 
move as many as possible of their cows, horses, goats, 
sheep, and poultry from the ground floor of the sleep- 
ing-lofts, they become fairly wholesome and quite 
tolerable temporary accommodation for the use of 
troops. 

The thing that causes this curious congestion of 
live-stock under the family roof, and also makes it 
very difficult to relieve, is that rural France is still 
constructed and organized on lines laid down in the 
tenth and twelfth centuries. Then the forests were 
full of wolves, and the roads were infested by thieves, 
brigands, and members of the nobility, and crops, 
live-stock, or other movable property left out of doors 
after dusk had about as much chance of surviving 
till morning as the proverbial snowflake in Hades. 

Consequently the French peasant, who has at 
least one of the attributes ascribed to his Bourbon 
kings, that he forgets nothing, has been so schooled 
by tens of centuries of bitter experience that he would 
no more dream of going to sleep at night without 
every one of his precious animals under the same roof 
as himself, where he can hear every noise they make 



222 THE DOCTOR IN WAR 

during the night and go to their assistance, than he 
would of leaving one of his children out in the street. 

This intimate and affectionate domiciliary asso- 
ciation has certain disadvantages — to the animals; 
and one of the bitterest complaints of misbehavior on 
the part of our troops, lodged with the Provost- 
Marshal in a certain village in the American zone, 
was that of an indignant old lady who came in to 
complain volubly through the interpreter that the 
troops billeted upon her talked so loud and so late 
at night that they kept her sheep and her rabbits 
awake! 

So ingrained has this instinct become, of housing 
all the peasant's belongings under the same roof at 
night, that when it was politely and gently sug- 
gested by the American officers of the day that the 
furred and woolly and feathered pets should be 
moved on to the barns, they were met by the simple, 
staggering objection that there were no barns. Any- 
thing approaching that character in the village was 
simply an annex of the house, or the house an an- 
nex of it, while in the fields around the village and 
in the open country there was not so much as a shack 
that would shelter a dozen chickens. 

This utter absence of every kind and sort of 
building in the fields, outside of the closely packed 
streets of the villages, is what gives a curiously 
half-wild, prairie-like, picturesque appearance to the 



OUR FIRST TROOPS IN FRANCE 223 

French country. However, after several conferences, 
out-buildings and sheds of different descriptions as 
remote as twenty or thirty yards from the parental 
roof were discovered, to which the dear creatures 
could be temporarily removed and yet visited once or 
twice during the night in order to keep them from 
dying of lonesomeness and a sense of neglect. 

Another small international complication that 
arose was that as soon as the wheat and oats were 
harvested, the peasants of some of the homesteads in 
which our troops were lodged insisted upon filling all 
the space except that actually occupied by the cots 
of our men, up to the roof with stacks and walls of 
sheaves. But the O.C. in that village was a born 
manager of men. He discovered in one of the barns 
a little one-horse threshing-machine, borrowed a horse 
from the transport lines, and called for volunteers. 
A dozen soldier boys who had been raised on farms 
responded promptly, and in five or six days' time the 
"gang" made the tour of the village and threshed 
out their whole small grain crop. This work not 
only made room for their sleeping quarters, but also 
raised them highly in the esteem of the community. 

All sorts of extraordinary and unheard-of accesso- 
ries are found necessary in modern war, but this is 
the first time that a threshing-machine has been 
placed in the list of articles available for military 
purposes. 



224 THE DOCTOR IN WAR 

When cleared of their animal boarders and cleaned 
and whitewashed, these billets make dry, commodious, 
and well ventilated, though rather dusty, quarters 
for troops in summer and fall. They have, however, 
the drawback that it would be very dangerous to 
have lights of any description in them at night, as 
the buildings are literal tinder-boxes which a spark 
will convert into a veritable fire-trap; especially as 
many of the loft and haymow sleeping-places of the 
men are reached only by rickety ladders of rough 
poles. 

Also, that they are almost impossible to heat or 
even dry out in winter-time, partly on account of 
their literally barn-like size and draughtiness, partly 
because many of them have no chimneys passing 
through or near them. One energetic young regi- 
mental surgeon had succeeded in partially solving this 
last difficulty by refusing to accept any quarters for 
billets in his particular village which had not a chim- 
ney running up one or other of their walls, into which 
stove-holes could be cut. 

As he had a good village and a small detachment, 
he succeeded in getting the sort of quarters he wanted 
by firmly sticking to it, but all billeting officers are 
not so fortunately situated — nor so resourceful and 
determined. 

It was expected that before the seriously cold 
weather sets in, supplies of lumber will have been 



OUR FIRST TROOPS IN FRANCE 225 

secured sufficient to build comfortable wooden bar- 
racks with double walls, stoves, and real windows, 
for the housing of the troops after the manner of the 
French and English camps. Lumber is another of 
the peaceful and inoffensive articles which has sud- 
denly found itself contraband of war in this struggle. 

So far has the demand outrun the ordinary supply 
that both the English and the French Army au- 
thorities have found it necessary to organize gangs 
of lumbermen, picked out of the troops, and supply 
them with portable sawmills and set them to work 
in the woods and forests in or near the army zone. 

The modern army devours lumber like the locusts 
do growing crops, for barracks, for hospital wards, 
for headquarters and office buildings, for storage 
sheds, for railway platforms, for sidewalks, for the 
walls and roofs of galleries and mines, for dug-outs 
and underground shelters, for trench walls, and for 
temporary roads over boggy places, corduroy fashion, 
to bring up the priceless guns. 

Gangs of lumberjacks have already been organized 
in the American zone, and sawmills ordered, and as 
soon as they arrive the ancient woodlands of France 
will begin to suffer, to furnish the means to protect 
her soil from the invader. Don Quixote went to war 
with windmills, but never since his day has any 
general found it necessary to equip his troops with 
sawmills and threshing-machines. 



226 THE DOCTOR IN WAR 

In the meantime our boys are hard and brown and 
vigorous, and thanks to the vigilance and skill of 
our Army Medical Corps, have a sickness rate which 
is almost what the French call "une quantite ne- 
gligeable." Probably it is just as well for them to 
start from the ground, as it were, begin with the 
most primitive and work their way up from tents in 
Texas to billets in the training zone in France, to the 
full modern conveniences and sanitary comforts of 
twentieth-century war. 



XIII 

NEW FACES FOR OLD AND MAKING A 
FRACTION EQUAL A WHOLE 

NOT the least wonderful of the triumphs of sur- 
gical skill in this war have been won over 
those most dramatic and shocking of shell injuries — 
wounds of the face and jaws. These, while perhaps 
not more common than bullet wounds of the same 
region in former wars, have taken on a far more se- 
rious and ghastly character on account of the great 
size, jaggedness, and terrific momentum of the shell 
fragments. 

A bullet would go completely through the face 
from side to side, and perhaps break one jaw or put 
out an eye; but a whizzing, whirling boomerang of 
a jagged shell splinter disdains such feeble damages 
as this and will often shear away the whole lower half 
of the face, leaving the tongue hanging down on the 
chest, or tear away an eye, all the front of the upper 
jaw and teeth, and one side of the lower jaw at one 
swoop. 

The worst case of all that I saw was a poor Eng- 
lish boy, who had lost completely both eyes, his nose, 
the front third of his upper jaw, and about a quarter 
of the front of his lower jaw, including the chin and 



228 THE DOCTOR IN WAR 

lower lip and tip of his tongue. His face when the 
dressing was taken off was just one succession of 
bloody craters below another. At first sight the pity 
seemed to be that he had survived at all. But within 
six months that poor youngster had been given new 
fronts to both of his jaws by bone grafts, capable of 
carrying full plates of artificial teeth so that he could 
chew perfectly, a new nose, by combined bone and 
skin grafts, and a new lower lip. Enough of the eye- 
lids were left on one side so that by skillful repairing 
he was able to wear one glass eye, and a carefully 
tinted enamel-coated metal plate held in place by 
a pair of spectacle frames completely covered the 
gap in his other orbit. So that his artificial face, 
while far from handsome, was quite presentable 
enough to allow him to go about his work and appear 
on the streets or anywhere else in public without 
attracting special attention or causing any feeling of 
repulsion in those who met him. The only thing that 
could not be restored for the poor chap was his sight. 
These wizard-like results have been brought about 
by a combination between the dentist and the sur- 
geon, sometimes in the person of a single individual, 
a dentist who is also a graduate in medicine and has 
made a specialty of the surgery of the face and jaws; 
sometimes by a dentist and a surgeon working in co- 
operation; one doing the tooth and splint work and 
the other the surgery proper. 



NEW FACES FOR OLD 229 

How can the miracle of building new faces in place 
of old ones be wrought? Suppose that the case is one 
where a part of the upper jaw and most of the nose 
and upper lip have been torn away: after the bleeding 
has been stopped, and the worst of the infection has 
worked its way out of the great ragged wound and 
it is beginning to show signs of healing, the remain- 
ing teeth in the jaw in front of and behind the gap 
are tackled by the dentist, cleaned, if necessary filled, 
and used as the pillars for the attachment of a curved 
metal or wire splint bridge which temporarily fills 
in the gap. After the tissues have become somewhat 
accustomed to this, it is taken out and a regular dental 
plate carrying the missing number of teeth is fitted 
in in its place. 

This restores the " bite " on that side and the prob- 
lem of the lip and side of the nose is tackled. This 
can be met in several ways depending upon the size 
of the gap. If of moderate size, it can be filled by 
dissecting up a pear-shaped patch of skin from the 
temple behind or from the forehead above, care- 
fully planned so that the " stalk* ' of the pear con-> 
tains the artery which supplies the patch with blood. 

Then the patch is twisted round on its stalk and 
drawn down or forward to cover the gap and skill- 
fully stitched into place all round its edges. Having 
still its own blood-supply, it keeps alive until it has 
grown fast in its new bed and then the stalk of the 



230 THE DOCTOR IN WAR 

pear is cut across and the transplanting of the flap 
is complete. The gap left in the skin of the forehead 
or temple can either be closed by sutures or coated 
over with skin grafts. 

If the gap in the lip and nose is too great, or, as 
unfortunately often happens, the skin of the forehead 
and temple has also been badly gashed and damaged, 
then a more radical and complicated method is re- 
sorted to. One of the patient's arms is bent and laid 
across his face in such a position that the inner side 
of his forearm lies in contact with the damaged 
side of his face. It is then bandaged firmly in posi- 
tion, the hand being spread out over the top and 
side of the head, and a flap of skin of the desired 
size and shape is dissected up from the soft, deli- 
cate inner side of the forearm. It is twisted round 
upon its stalk, stitched into position, and when it has 
firmly taken root, the stalk is cut across and stitched 
under as before, and the arm released from its un- 
comfortable position and set at liberty. 

If part of the bridge of the nose and one nostril, 
say, have been carried away, this flap of skin will need 
some support. So an incision is made under local 
anaesthesia over one of the patient's ribs, a little strip 
of bone just the right size and shape to fill the gap 
in the bridge of the nose is deftly sawed out of it 
with a tiny buzz-saw driven by a dental engine slipped 
into the bed prepared for it underneath the new skin 



NEW FACES FOR OLD 231 

of the bridge of the nose, and behold the patient 
has as Roman or even aquiline a nasal prominence 
as he ever had before. 

. Such is the indomitable pluck of the soldier boys 
that they make all sorts of suggestions to their doc- 
tors as to improvements they would like to have made 
in the shape or height of their noses. If they must 
have a new nose, they might as well have one to their 
liking, instead of being doomed to go back to one 
whose defects they may have been sadly conscious 
of. They were not consulted about the noses they 
were born with, but here is their chance to get one 
that suits them. 

If it be part of a lower jaw and chin which has been 
sheared away, the same methods of wiring or plate 
splinting together of the teeth on each side of the gap 
are followed. The lip and chin are restored by flaps 
taken from the cheek or neck or from the forearm 
if necessary. But the gap in the jaw needs further 
attention because to get a really satisfactory result it 
should be filled by bone if possible. So a little socket 
is cut with a dental saw in the bone at each end of 
the gap, a rib is cut down upon as before, and a long 
enough piece of it carefully sawed and. dissected out 
to fill the gap in the jaw-bone and fit accurately into 
these sockets cut at each end of the gap: a long- 
belated revival of the famous operation in the Gar- 
den of Eden, but not so utterly surprising, for the 



232 THE DOCTOR IN WAR 

Garden itself has been dragged into this war. Then 
a careful hunt is made for any strips of periosteum 
which may be left, the mucous membrane of the 
mouth is laid open and carefully stitched with these 
strips over the piece of rib so as to bury it completely. 
With good luck it will take root in its new position 
and the patient will again have a good firm lower 
jaw capable of moving all in one piece, although, 
of course, he will always have to wear a dental plate 
carrying teeth corresponding to those which have 
been lost. 

The main element of "luck" in these operations, 
either for bone splints or other repairs of the jaws, 
is the question of infection. And curiously enough, 
while the germs carried in on the shell fragments 
are bad enough, the surgeons assured me that the 
most important single factor in getting a good clean 
heal without suppuration or breaking down was the 
condition of the patient's teeth and gums as to cavities, 
abscesses, etc., at the time that he was hit. A clean 
mouth like a clear conscience is a mighty good thing 
to go into battle with. 

One hardly knows which to admire most highly, 
the dauntless pluck and cheerful courage of the 
wounded, who will submit to operation after opera- 
tion not merely with patience, but with enthusiasm, 
in the eager hope of getting rid of the haunting fear 
that they may be left objects of repulsion or dis- 



NEW FACES FOR OLD 233 

tress to their fellow-men; or the skill, the untiring 
devotion, and the painstaking enthusiasm of the den- 
tists and surgeons. No trouble is too great, no pains 
or ingenuity too laborious to rescue these poor fel- 
lows from lifelong disfigurement. And their persistent 
efforts are really astoundingly successful in- the end. 
One might think from the detailed description of the 
gruesome methods of patching, of flap grafting, and 
bone grafting used that the result would be at best 
a mere expressionless mask or a patchwork quilt of 
skin grafts with a couple of smaller holes for nostrils 
and a larger one for a mouth. 

But nothing of the sort is the case. The surgeons 
will go the length of a dozen operations with the en- 
thusiastic cooperation of the patient in order to 
attain not merely a workable mouth, but one which 
is as nearly as possible of the same shape as the origi- 
nal one, taking particular pains with the curves of the 
angles. They have devised the most ingenious meth- 
ods of sewing together the skin edges of the different 
flaps, carefully beveling off in opposite directions the 
edges and then burying their tiny sutures completely 
out of sight under the overhanging of the upper 
bevel, so that not only no stitch marks, but no scar 
is visible when healing is complete. 

The faces which they construct are really thoroughly 
lifelike and natural, though, of course, they have a 
slightly battered and " shop-worn* ' appearance. They 



234 THE DOCTOR IN WAR 

go at it in the most workmanlike and artistic style, 
their first request being that the soldier write home 
for a copy of his latest photograph so that they can 
have a model to work toward. There is a story — 
I repeat, a story — told at the Front about a young 
soldier who had had a terrific wound of the face, 
and who had been patched up in the most wonderful 
style. He complained only that when the surgeons 
wrote home for a copy of his photograph, the family 
made a mistake and sent one of his next younger 
brother; and they had made such a faithful copy 
of their model that he had no end of trouble with 
their best friends always mistaking them for one 
another, and even their mother could hardly tell 
them apart. But I tell this simply as it was told 
to me. 

• _ In the very worst cases, where the loss of tissue 
has been so tremendous that neither flaps nor bone 
grafts will fill the gap, another method is followed ; 
a cast is taken of the corresponding parts on the 
other side of the face. Then from this a thin metal 
plate is cast and coated with enamel accurately 
covering the gap and matching the other side. Then 
this is most carefully painted and tinted by artists 
who have volunteered for the service, and attached 
to a pair of spectacle frames which hold it firmly in 
position. So skillfully and successfully is the tinting 
and other camouflage done that at a glance one can- 



NEW FACES FOR OLD 235 

not tell where the edge of the mask leaves off and 
the living skin of the face around it begins. 

These wonderful masks are literally works of art 
in more senses than one; some of the best-known 
portrait and other painters of both England and 
France having volunteered to produce them as a 
labor of love and patriotic service. If the missing 
part of the face includes an orbit, a glass eye is in- 
serted in the mask, and then lids, eyelashes, and eye- 
brows carefully painted round it. In some cases to 
make the deception still more perfect, real hairs are 
stuck into the enamel of the mask for eyelashes and 
eyebrows. 

Another new situation which we had to face in 
this war was a large number of not merely broken, 
but badly shattered bones. The decent and modest 
round or pointed bullets of former wars broke bones 
frequently, but often would go completely through 
a limb without touching the bone at all, or perhaps 
just splintering a chip off it, and the wound left by 
them was a simple, rounded hole through the muscles, 
from one side of the limb to the other. 

But when a whirling, whizzing fragment of shell 
the size of a stove-lifter or of a flatiron strikes the^ 
limb, it gashes a hole that you could lay your whole 
fist into through all the muscles right down to the 
bone and shatters that into twenty fragments, and 
often converts half the limb into a mere mass of 



236 THE DOCTOR IN WAR 

bloody pulp. Every fracture in this war is a huge 
open wound, with a not merely broken but shattered 
and splintered bone at the bottom of it; and what is 
worse, the whole thing from top to bottom reeking 
with infection. 

The old-fashioned wooden or moulded metal splints, 
which covered from half to two thirds the surface of 
the limb, were hopelessly unsuited for these cases, 
where often nearly half the surface of the limb, 
counting front and back, was occupied by ragged, 
open wounds, on account of the great difficulty of 
dressing these wounds, and still more of irrigating 
them, with the splints and bandages in position. 
Even our former sheet anchor, a plaster-of- Paris cast, 
which could be snugly applied to the limb, and then 
holes, or "windows" as they were termed, cut in it 
just over the wounds, so that they could be reached 
for dressing, failed to fill the bill, partly because the 
huge size of the windows necessary weakened the 
cast, and partly on account of the discharges or irri- 
gating fluids working their way up and down the 
limb underneath it. 

So we scrapped these altogether, and took over 
from the orthopedic surgeons a skeleton splint which 
had been found of great value in straightening the 
limbs and healing the diseased joints of little chil- 
dren. This was known as the Thomas splint, or, from 
the American modification of it, the Hodgin. This is 



NEW FACES FOR OLD 237 

an extremely ingenious and at the same time simple 
skeleton splint, consisting roughly of a long iron rod 
about the size of a lead pencil, bent in the middle 
into the shape of a huge hairpin, about six inches 
longer than the limb. 

The ends of the hairpin are socketed into a large 
rounded wooden or hollow metal ring about an inch 
and a half in diameter, wide enough to slip com- 
pletely over the limb. This is slipped over the foot 
or head and pushed right up till it rests against 
the body — armpit or groin as the case may be — ■ 
in such a position that the rods lie one on either side 
of the broken limb and the "bow" projects beyond 
the foot, stirrup fashion. Then a series of strips 
of bandage are carried across from one rod to the 
other underneath the limb and tied separately, so that 
the broken bone is supported on a sort of banded ham- 
mock, each band of which can be shortened or loosened 
as may be needed to make it rest comfortably. 

A bandage is carefully applied to the ankle or wrist 
and the ends of that carried round the cross-bar or 
bow of the hairpin below the hand or foot, then the 
limb is gently pulled into good position, the bandage 
is tightened to hold it there, and the wounded limb, 
thus held in good position, is perfectly comfortable, 
and what is most important of all, with every inch 
of its wounded surface accessible at five seconds 
notice for dressing or treatment. 



238 THE DOCTOR IN WAR 

These skeleton splints are now kept on hand in 
every Advanced Dressing-Station, and even car- 
ried by the stretcher-bearers out into No Man's 
Land; so that the shattered limbs of the wounded 
may be "immobilized" and kept comparatively com- 
fortable on their trip down to the Casualty Clearing- 
Station. 

B At the Casualty Clearing-Station, there are whole 
wards, and a little farther back whole hospitals, 
which are devoted exclusively to the treatment of 
fractures, particularly of the arms and legs. In these, 
great wooden suspension frames are built up over 
the beds like a sort of miniature traveling crane. 
These are most ingeniously equipped with little trav- 
eling carriages, pulleys and weights, rollers, and ad- 
justable derricks, so that the injured limb is slung 
from them and skillfully supported in the precise 
position which is best for its healing and the pa- 
tient's comfort. To keep the limb from shortening 
and the shattered fragments of bone from healing in 
bad position, which is one of the greatest problems 
of fracture treatment, a sort of stirrup is carefully 
fastened to the foot by means of overlapping strips 
of rubber plaster, or sometimes by a sort of laced 
or buttoned gaiter. From this stirrup a cord is run 
through a pulley on the framework at the foot of the 
bed, and a weight attached to the end of it, care- 
fully adjusted so as to be just heavy enough to 




A FRACTURE CASE IN A HOSPITAL ON THE WESTERN FRONT 



NEW FACES FOR OLD 239 

keep the limb stretched at the proper length and in 
good position without fatiguing or over-stretching 
the muscles. 

The shattered fragments of bone are drawn and 
manipulated into good position under ether with 
the aid of the X-ray, and then held there by the ten- 
sion of springs or the pull of weights over adjust- 
able pulleys. Then the damaged parts of the muscles 
are carefully cut away and the ends stitched skill- 
fully together. The smaller damaged arteries are 
tied, and if the great main artery of the limb is torn 
or even cut across its walls, they can be brought 
together and stitched with fine catgut as neatly and 
closely as a tailor will mend a rent in a coat. 

Even in such desperate conditions as the destruc- 
tion of an inch or more of the great main artery, a 
carefully sterilized tube is slipped into the upper 
and lower ends and tied in to bridge the gap between 
them for a few days, until circulation can be estab- 
lished through some of the smaller side branches 
above and below the wound, when it is removed and 
the artery tied. . 

The net result of all this patient and laborious 
and painstaking skill is that out of ten arms or legs 
which would have been considered helplessly doomed 
to amputation twenty years ago, nine are now saved. 
A little weaker or stiffer, or an inch or so shorter, 
perhaps, but far superior to any wooden or leather or 



240 THE DOCTOR IN WAR 

steel and cork, or other artificial limb ever invented. 
These fracture frames set up over the beds are strong 
enough to support and sling up not merely an arm 
or a leg, but the whole body as well when necessary, 
as in wounds in the back and hips, and so perfect 
is the control of the position of the limb by their 
pulleys and cords, that even a badly shattered frac- 
ture of the thigh may be healed with a straight limb 
and little or no shortening, in some cases actually 
none at all. Furthermore, apart from this they would 
be worth all their cost and care just for the relief they 
give to the poor wounded, who after the weight and 
cradles have been properly adjusted, and they have 
got accustomed to the new position of the limb, can 
move about in bed and feed themselves and rest 
comfortably, and sleep as peacefully as children. 

One devoted and enthusiastic young surgeon con- 
fided to me that in the beginning, when the appli- 
ance was new to him and he was most anxious to be 
on the safe side and to prevent any shortening, which 
is the rule in eight fractures out of ten, he had ac- 
tually so thoroughly straightened and stretched a 
broken leg that it came out slightly longer than the 
sound one! But this was a minor and pardonable 
fault, as it only meant putting the extra half -inch 
heel on the boot of the sound side instead of on the 
broken one, and the patient would never know the 
difference. 



NEW FACES FOR OLD 241 

The same enthusiasm gave beautiful results later, 
as he showed me in^ne ward nine men with severe 
fractures of the thigh who had been less than a week 
out of their slings, and who could walk the length of 
the ward and back without either a stick or a limp. 

Nothing strikes one more forcibly in this war than 
the extraordinary toughness and powers of adjust- 
ment and resistance of the human machine. One 
scarcely knows at which to marvel most — the way 
in which men who have lived the sheltered, peaceful 
humdrum life of modern civilization all their days, 
never seen a shot fired and scarcely a blow struck 
in anger, within a few days or weeks come to take 
battle, murder, and sudden death as a matter of 
course and routine and face the most incredible of 
horrors and risks as part of the day's work, with- 
out turning a hair; or the way in which the most 
frightfully torn and shattered and mangled rem- 
nants of human stuff in the hospital, under the pa- 
tient skill of the surgeon and the sleepless care of the 
nurse, will pull themselves together again into some- 
thing resembling symmetry and the human form. 

Luckily humans are not like Humpty Dumpty — 
they can be "put together again," without even call- 
ing in " all the King's horses and all the King's men." 
And the wonderful way in which the disabled and the 
crippled can be put together again, and made, not, 



242 THE DOCTOR IN WAR 

of course, as good as new, but skilled, efficient, self- 
supporting workers, is one of the medical triumphs 
of the war. 

This calls for a new and special type of hospital, 
not merely a building with wards and beds and an 
operating-room and a staff of nurses and doctors, 
but an establishment roughly one third hospital, one 
third gymnasium and massage rooms, and one third 
manual-training school. So that directors of physi- 
cal training, masseurs, and electro-therapeutists and 
teachers, particularly of manual-training schools and 
polytechnics, are as necessary and important mem- 
bers of the staff as surgeons and nurses. The nub of 
the problem and aim of the whole establishment is 
not so much how well and how symmetrical a man 
may be made to look again, but how good a living he 
can be trained to earn for himself. 

This type of re-education hospital is particularly 
well managed and carried out in France. One famous 
one in Paris is installed in a great art gallery and 
exhibition building, the same where in happier times 
are displayed every year the pictures of the famed 
French Salon. Though the patients are not brought 
here usually until six months after they are wounded, 
and their wounds are nearly closed, yet so jagged and 
so horribly infected are the lacerations made by mod- 
ern shell fragments that it often takes months and 
even years for them to heal completely and soundly. 



NEW FACES FOR OLD 243 

This period is taken advantage of, for re-educating 
them for their life-work. 

To everybody's delight it has been found that in- 
stead of delaying their recovery this actually hastens 
it distinctly and improves the final results. Indeed, 
the modern "joint" surgeon does not hesitate to say 
frankly that as much harm is as often done in the 
way of stiffening joints and paralyzing muscles by 
keeping wounded limbs too long in badly shaped 
splints or plaster casts, as by the original injury it- 
self. Get the limbs out of their casts and splints and 
set their own muscles to work as quickly as possible, 
pulling them back into shape and usefulness, is their 
motto. Our methods of treating fractures of bones 
and injuries of joints have been simply revolution- 
ized already by our experience in the war and will 
benefit thousands in future years after this terrible 
strife is ended. 

By one of those curious reversals that war so often 
brings, the surgeons best fitted to treat these bearded 
warriors were those who had made a specialty of 
straightening the limbs and restoring the joints and 
bringing back the paralyzed muscles of little children, 
or orthopedists as they are termed. So that the healer 
of little children has become second only in impor- 
tance in this war to the general or operating surgeon 
and great hospitals are being built for him and his 
students all over the warring countries. Thus our 



244 THE DOCTOR IN WAR 

cripples have to " become as little children " in order 
to enter the kingdom of healing. 

One of the largest halls of the great Art Gallery 
in Paris was turned into a hospital ward where the 
men slept; beautifully light and airy, with gayly 
frescoed walls, but a little bit difficult to heat in 
winter-time, it was murmured. The smaller halls 
were occupied by a series of work-shops, some in 
which the patient himself was worked upon by all 
sorts of vibrators and batteries and electric currents 
and exercising machines of the Zander type, and the 
others in which the patient worked upon the ma- 
chines and materials provided to learn his new trade. 

While he was being massaged and shocked and 
pulled and pounded and exercised back into shape 
in the shops in which he was the raw material, the 
strength of the different groups of his muscles, and 
the amount of movement of which his joints and 
limbs were capable, were carefully tested out and 
measured. From the results were estimated first of 
all what his total strength was, whether he should 
be rated as quarter-man, half -man, or three-quarter 
man, so as to place him in the light, medium, or 
heavy-work class. Then the strength or deficiency 
of the different groups of his muscles was tested in 
order to find some particular occupation or task in 
which his strength could be used and his disabilities 
would not interfere. Then, after a preliminary try- 



NEW FACES FOR OLD 245 

out to see whether he showed any aptitude for this 
particular job, or whether something else might fit 
his natural tendency or previous training better, he 
was set to work to learn his new trade. 

There was nothing rigid or forced about the 
method, if the "mutile" did n't make good progress 
and take kindly to his scientifically selected trade, 
he was tried out on another one. In fact, the men 
were not infrequently given training in two or more 
trades which could be carried on together in villages 
and little country towns — such as cobbling and tool- 
sharpening, for instance — where there might not be 
enough demand for either alone to make a good 
living. 

In all there were some nineteen or twenty differ- 
ent trades taught, ranging from carpentry, cobbling, 
metal-work, and harness-making to photography, 
book-binding, and printing. 

The Director, who was a doctor and physical di- 
rector of a large college gymnasium, was an enthu- 
siast and inspired his patients with the same spirit. 
It was a pleasure to see the enthusiasm and energy 
with which they went about the work of overcoming 
their defects. Thanks partly to the universal use of 
machinery in modern industry, so that great mus- 
cular strength is no longer necessary, partly to his 
devoted skill in fitting the disabled man to the par- 
ticular task which suited him, the doctor assured 



246 THE DOCTOR IN WAR 

me that, somewhat to his own surprise even, he was 
able to make more than two thirds of his patients 
"full hands" at some particular trade. 

Then he brought his infectious enthusiasm to bear 
upon the employers and brought them to see that so 
long as a man did full work they must pay him full 
wages, regardless of how much of him might be miss- 
ing: with the gratifying practical result that not one 
of his graduates was earning less than eight francs 
a day, which was very good wages at French rates, 
the equivalent of nearly four dollars a day, Ameri- 
can standard ; men after training earned more. 

As something like two thirds of the population of 
France is peasant, special attention was given to 
" little" trades, like cobbling, harness-making, tool- 
grinding, tailoring, etc., such as could be carried on 
in small villages. And in addition there was a spe- 
cial branch affiliated with the hospital, a farm school 
out in the country, where the cripples who wished 
to go back to the soil could receive special training 
in modern methods of farming, particularly garden- 
ing, dairying, and what the French call "la petite 
culture"; that is, poultry, rabbits, bees, etc. This 
school is situated on a beautiful old French farm, 
about ten miles from Paris, close to a large military 
hospital, where the pupils live and receive such medi- 
cal care as they need during their course. 

Happily the number of these hospital schools re- 



NEW FACES FOR OLD 247 

quired will be smaller in proportion than in any pre- 
vious war, on account of the splendidly successful 
way in which the Hospitals at the Front have done 
their work. So far it is estimated that the cripples 
and severely disabled men are about one tenth of the 
men killed, — that is to say, from two to five per 
cent of the wounded, — but there will be enough at 
the best, Heaven help us ! 

After visiting France one is frequently asked 
whether the eye is not perpetually saddened every- 
where, on the streets and in the trains by the sight 
of pitiable cripples — armless, legless, blinded, and 
otherwise terribly mutilated victims of the war? 
The answer is, not to anything like the extent which 
one would have expected, partly because the surgery 
has been so skillful and successful, partly because 
the crippled soldiers, instead of being sent home or 
turned out to shift for themselves, are splendidly 
taken care of in these great re-educational establish- 
ments until they can be fitted to a new niche in life. 
Finally, because, when their re-education is completed, 
their shattered joints limbered up, their new arms 
and legs carefully fitted in the best modern style, 
they are able to go about their work so briskly and 
confidently that in their street clothing the average 
eye would hardly recognize them as cripples. 



XIV 

THE NEW DISEASES OF THE WAR 

THIS war, though it has introduced many new 
and unexpected situations, has added little 
that could be really termed original, not even in the 
realm of disease. Only three diseases have appeared 
in four years of it which could really be termed new, 
and these all bear the name of its most striking fea- 
ture, Trench Fever, Trench Nephritis, and Trench 
Feet. These are comparatively mild diseases, not to 
be compared in either dangerousness or frequency 
with typhoid, diarrhoea, or dysentery in the old days, 
and seldom prove fatal. But they are severe enough 
to disable a soldier and common enough to be annoy- 
ing, and what makes them particularly exasperating 
is that after years of laboratory research we are still 
in the dark as to the cause of the last two and only 
partially enlightened as to the first. 

Trench fever is a curious relapsing fever something 
like a mild form of malaria. The patient comes down 
with a sharp rise of temperature, and pains in his back 
and limbs, then after four or five days of fever he im- 
proves and seems to be getting better, and suddenly, 
without any apparent cause, up goes his tempera- 
ture again, and so the process repeats itself for Jour 



NEW DISEASES OF THE WAR 249 

or five weeks. He is never very seriously ill and usu- 
ally recovers completely when he is sent back to the 
Base or to England, but he is "off the strength" 
for a considerable time and is rather apt to break 
down again with another attack after he comes back 
to duty. 

Though a number of organisms have been accused 
and " shadowed," the criminal one has not yet been 
discovered, but there has been a growing consensus 
of opinion that the disease is due to an infection car- 
ried by the bite of the louse, supported by the fact 
that the disease is becoming distinctly less common 
as the trenches are better drained and sanitated, and 
the men well supplied with hot shower baths and clean 
underwear. 

Indeed, within the last few months, the problem 
has been definitely and successfully attacked by the 
ever-victorious method of direct experimentation 
upon human volunteers. Groups of soldiers, chiefly 
from the Medical and Sanitary Corps, volunteered 
for this splendid service to humanity, first in the 
English and Canadian and then in our American 
army hospitals, with the result of conclusively prov- 
ing that trench fever, like typhus, was transmitted 
by the bite of the body louse, now enjoying a wide 
notoriety, if not favorable reputation, under the 
name of "cootie." 

Insects which have been living upon men know?l 



250 THE DOCTOR IN WAR 

to be infected with trench fever were transferred to 
the bodies of healthy men, but the first results were 
somewhat puzzling, inasmuch as while infection did 
sometimes take place, this was only in a small propor- 
tion of cases, and in some groups the result of lice 
transference was almost entirely negative. 

What made this the more puzzling was, that the 
disease could be surely and promptly transmitted by 
inoculating healthy men with the blood of those suf- 
fering from it. There must be some third factor at 
work, and this turned out to be a rather unexpected, 
and to say the least of it, a rather distinctly unaesthetic 
and undignified one. It suddenly occurred to one of 
the younger doctors that the men who were volun- 
tarily undergoing this experiment were bearing the 
discomfort of their infestation in the most Spartan 
fashion, and were scarcely scratching themselves at 
all. On inquiry he quickly found that having sub- 
mitted themselves for this serious and most important 
experiment, they considered that it was beneath 
their dignity to scratch, and also that it might per- 
haps interfere with the success of the experiment 
and the accuracy of the result. 

A suspicion dawned in the young man's mind that 
perhaps their stern and stoic self-restraint might have 
produced just the opposite effect from what was in- 
tended, and he thereupon gave them free leave and 
license to excoriate their itching surfaces as heartily 



NEW DISEASES OF THE WAR 251 

as they wished. The result was that every one of the 
squad developed a beautiful case of the disease within 
four or five days. 

The secret of the disease was discovered. The 
pestilent insect unquestionably infected itself through 
the blood which it drew from the patient, but appar- 
ently only occasionally secreted the germ through 
the glands of its mouth parts, as the mosquito, for 
instance, does the malaria germ, so that it was only 
occasionally that its new host would be infected by 
its bite. But if the whole body of the louse was 
crushed upon the surface of the skin and then rubbed 
into the tiny abrasions produced by scratching, the 
germs in its body would be certainly absorbed into 
the new patient's blood. It also appeared that the 
excreta of the lice contained the germs of the disease, 
and that these, when deposited upon the skin and 
scratched in, would infect the new host. 

Again, as often happens, duty and pleasure do not 
run hand in hand, and the best cure for the itch is 
not, as the old pessimistic proverb used to have it, 
"to scratch,' ' to say nothing of avoiding trench fever. 

So that by the free use of the liot shower bath for 
the bodies of the men and the steam sterilizer for 
their clothing, in the now famous and unspeakably 
beneficial "delousing" or " unlousing" establishments 
described in the chapter " Mountains and Medicine," 
not only will this distressing disease be stamped 



252 THE DOCTOR IN WAR 

out, but the Army will be relieved from one of the 
most annoying and exasperating of its discomforts. 
Great progress has already been made in this latter 
direction already, and it would be safe to say that 
infestation with "cooties" has become the exception 
instead of the rule in our armies. And with this 
added incentive to push to its utmost limit the fight 
against these wretched little pests, of stamping out 
trench fever, which was estimated at one time to keep 
nearly five per cent of the Army in the field more or 
less constantly on the sick list, the plague will ere 
long be stamped out altogether. 

Trench nephritis, as its name implies, is a slow 
inflammation of the kidneys with albumen in the 
urine, a sort of mild and curable form of Blight's 
Disease. Like trench fever it runs a slow and irregu- 
lar course and usually ends in recovery — indeed, 
the few cases which do not are mainly those in which 
there is reason to believe that some chronic disease 
of the kidney had existed before the attack. 

Various causes are suggested for trench nephritis 
— the terrific exposures to wet and cold and mud in 
the trenches, germs from the trench mud, sudden 
strains as of emergency marches under heavy packs 
falling upon men of indoor occupations and trades, 
irregularities of diet, etc. — but none of them have 
been definitely proven. The weight of opinion is 
rather in favor of the view that all these play their 



NEW DISEASES OF THE WAR 253 

part and that the disease is not due to a germ, which 
is rather supported by the fact that it is most com- 
mon in winter, and that a battle or extensive chang- 
ing of lines, with long, exhausting marches, is often 
followed by a fresh crop of cases. 

It is significant that in these alternations of violent 
activity with comparative stagnation, the natural 
food relations are reversed, the rations being some- 
what scantier, drier, and less attractive on route 
marches and in the front-line trenches, and very 
abundant and attractive in the rest-camps and under- 
ground galleries in support behind the third-line 
trenches. 

At all events, strong and successful efforts are 
being made to equalize and balance up between the 
alternations, both of extremes of activity and of 
food, so far as the stern necessities of war will permit ; 
sending up at great risk to life regular supplies of hot 
food to the front-line trenches and cutting down 
upon wastefully abundant rations in the rest-camps, 
while pack drills and practice marches are kept more 
within the limits of endurance of the less sturdy men, 
and the amount of active exercise and even light 
labor in the rest-camps increased — considerably 
more, in fact, of the latter than Mr. Thomas Atkins 
or Jacques Poilu appreciates with any cordiality. 
And the disease, whether in consequence or as a 
coincidence, is distinctly diminishing in both severity 



254 THE DOCTOR IN WAR 

and frequency as these and other health conditions 
are more carefully studied and adjusted. 

When the full misery and hardship of trench war- 
fare in snow and sleet and bottomless mud began to 
dawn upon us in the gloomy winter of 19 14, one of 
the torments that stood out first and most promi- 
nently was a painful and peculiar inflammation of 
the feet, ankles, and legs, dubbed by the soldiers 
"trench feet." It looked and behaved like a cross 
between chilblains and frozen feet. The feet would 
first swell and turn dull red and purplish; then the 
skin would begin to itch and burn intolerably ; then, 
if bathing and antiseptics did not check the process, 
little blisters and pustules would rise up all over the 
surface, the purple color would deepen to bluish 
black, and a superficial gangrene of the top of the 
foot and toes and occasionally the soles would be- 
gin to set in. So severe was the gangrene that large 
patches of the skin and surface of the feet would die 
and slough away completely, while in the worst forms 
it would look as if an amputation would have to be 
done in order to prevent the absorption of the poisons 
of decay into the system. 

It was an extremely obstinate, painful disease, and 
while as a rule it could be checked with little worse 
than the sloughing and ulcerating away of a few 
patches of skin, it threatened to become serious from 
a military point of view, for it was almost totally 



NEW DISEASES OF THE WAR 255 

disabling while it lasted, and at one time was so com- 
mon that it was estimated that nearly ten per cent 
of the soldiers in Flanders and Northern France, on 
both sides of the fighting line, were constantly laid up 
by it. In fact, it became so troublesome that a special 
commission was appointed to inquire into its causa- 
tion and see what could be done to prevent it. 

Because the disease first began in winter, when the 
men were complaining bitterly of the cold and also 
because it started like an attack of chilblains and 
ended like a bad case of frost-bite, it was supposed 
that extreme cold combined with wet was an im- 
portant factor in causing it. But it was quickly found 
that although the cold undoubtedly aggravated and 
hastened the process, as a matter of fact the mud and 
the water in the trenches were almost never frozen, 
so that the men's feet were seldom exposed to a tem- 
perature below freezing: certainly not enough to pro- 
duce genuine frost-bite, or anything approaching it. 

Moreover, the disease showed no special tendency 
to diminish with the coming of the warmer weather 
in the spring, except where special measures had been 
taken against it. I was much interested to discover, 
on my visit to the Italian Front, that during the first 
year of their trench warfare, their soldiers had suffered 
very severely and extensively from trench feet, al- 
though such a thing as a frost is rare along the Isonzo. 
In fact, Gorizia, Gradisca, and Monfalcone are all 



256 THE DOCTOR IN WAR 

celebrated as winter health resorts. But they had 
plenty of the two real causes of the disease : undrained 
trenches and infected mud. 

The first thing discovered that pointed in the 
direction of relief was that pressure of both boots 
and leggings had a good deal to do with the produc- 
tion of the disease. The army boots were fairly com- 
fortable and loose-fitting, but the soldiers, knowing 
that they would often be standing up to their ankles 
or to their knees or even waists in thin mud or water, 
naturally were inclined to lace up their boots as 
tightly as possible, so as to keep them from leaking 
from above. This seriously interfered with the return 
circulation of the blood in the feet and started them 
to swelling, which, of course, raised the pressure still 
higher and set up a regular "vicious circle." 

Boots at least two sizes too big for ordinary wear 
or marching purposes were issued to the men, and 
they were instructed to wear heavy woolen socks 
and to avoid lacing their boot-tops too tightly. But 
the more serious binding was found to be due to 
the puttees and leggings worn by the men, and of 
the two, most unexpectedly, the puttees were the 
worst. 

This was due to the fact that in order to hold in 
place and present a trim and soldierly appearance, it 
was necessary to wind these curious woolen leg- 
bandages so tightly that the big surface veins of the 



NEW DISEASES OF THE WAR 257 

legs were severely pressed upon, making the feet first 
swollen and then cold. 

New methods of winding them round the legs were 
devised, after the fashion of what is known as a 
"spica" bandage in surgery, which would enable 
them to cling to the leg and yet hot grip it too 
closely, and by means of this, with the looser shoes 
and double socks, the amount and severity of the 
disease were considerably reduced. 

Still it continued troublesome, until the idea finally 
took shape that the real, underlying cause of the 
plague was neither wet nor cold nor tight foot-wear, 
but slow infection of the skin from constant soaking 
in the foul, infected mud of the trenches. 

This was attacked in two ways: By installing a 
regular system of motor-driven pumps to empty out 
the low spots, or specially constructed drainage pits 
and basins in the saps of the trenches. Another way 
was the extension of a complete system of the blessed 
duck-walks or wooden grating sidewalks which are 
elsewhere described. 

But the finishing touch in the conquest of the 
plague was put, I am happy to say, by another 
American invention, and that was the good, old- 
fashioned hip rubber boots of our happy boyhood 
days in the duck-swamps and the trout-streams. 
Duck-boards and duck-boots together were the win- 
ning combination. 



258 THE DOCTOR IN WAR 

I found along the English Front in Flanders, at 
the Battalion Headquarters of each section of low- 
lying trench, hundreds of pairs of high rubber boots 
which were issued to the men as they went on duty 
for their three days' turn in the front trenches. 
With real English thoroughness there was also a 
special drying-chamber, to which the boots were 
promptly taken as the men turned them in on their 
return from duty, where they were dried and warmed 
on special racks, so as to be in good condition for 
issuance to the ingoing squad next day. These, with 
plenty of thick woolen socks inside, are an almost 
perfect preventive and protection against trench feet. 

One other element, however, was found to be quite 
important, although it sounds at first sight rather 
trivial, and that was thorough and scrupulous clean- 
liness of the men's feet and frequent changing of their 
socks. 

One cheerful young subaltern, whom I met on a 
train, who did not know I was a doctor, was good- 
naturedly grumbling at the dreadful amount of what 
he called "nursemaid work" which an officer was 
nowadays required to do for his men. "Why, you 
know," he said, "these doctor johnnies have got such 
a lot of fussy regulations passed that I actually have 
to see, not only that my lot get clean underwear and 
clean socks twice a week, but that they put 'em on, 
and if they haven't got 'em on when inspection 



NEW DISEASES OF THE WAR 259 

comes, I get a wigging. I 've got to go round every 
night and see that they have greased their little feet 
and washed their pretty pink toeses before they go 
to bed. But I'm bound to say that the beggars keep 
as fit as fighting cocks with it all." 

Greasing the feet and legs with whale-oil or other 
thick tenacious grease and keeping the men moving 
and stamping about in the trenches, so as to keep 
up good circulation in their feet, were found also 
helpful. 

The same method applied to the trench feet in the 
Italian Army produced an almost complete clean-up 
of the condition. 

Now that trench warfare has been reduced to a 
science, new intrenchments are dug and planned with 
special reference to drainage as well as to defense. 
Rain and earth mixed together make mud, but they 
have to be churned and kneaded into each other to 
develop any considerable degree of either depth or 
gumminess. If anything like a reasonable slope for 
the drainage of rain and storm water is provided, 
even the clayeyest and stickiest of soils will "shed" 
two thirds to three fourths of the water that falls on 
it before it has time to be kneaded into paste. So 
that with scrupulous cleanliness, loose, warm foot 
and leg wear, and reasonably drained and grated 
trenches, the soldier who now enters the line of battle 
need have little fear of trouble from trench feet. 



2<3o THE DOCTOR IN WAR 

The disease has diminished in a most rapid and 
gratifying manner and such cases of it as now occur 
come chiefly after a long offensive like those of last 
autumn- when men have gone forward from the 
trenches altogether and been obliged to hold posi- 
tions consisting simply of shell-holes half-full of mud 
and water for days at a stretch. When visiting the 
Front in Flanders in April last year I had hard work 
to find a well-marked typical case of trench feet, but 
on returning in October, after the capture of the 
ridges, I saw quite a considerable sprinkling of cases 
from shell-hole conditions of this sort, but they were 
fortunately of rather a mild type and all rapidly 
recovering. 

One decidedly interesting and consoling fact 
strikes one very forcibly all along the battle-line, and 
that is that in spite of the most terrific and constant 
exposures to cold and wet and mud, in the most abom- 
inable of weathers there has been extraordinarily lit- 
tle rheumatism, or gout, or neuritis of any sort. This 
is the more striking because the troops have in addi- 
tion been exposed in a very high degree to the other 
supposed cause of rheumatism, red meat and uric 
acid in all its forms. The men have had practically 
all the meat that they could eat and all the tea or 
coffee they could drink twice and sometimes three 
times a day — not merely for months, but for years, 
and yet gout, rheumatism, and arterio-sclerosis are 



NEW DISEASES OF THE WAR 261 

conspicuous by their absence. A more complete and 
overwhelming explosion of the vegetarian delusion 
and the uric acid myth could hardly have been 
imagined. 



XV 
KEEPING THE CAMPS HEALTHY 

NEXT after putting a roof of some sort over the 
soldier man, and walls round him to enclose a 
small slice of the universe, cut out of the wide, wide 
world, which could be heated and dried at pleasure, 
comes the question of keeping him dry under foot. 
Or, in other words, keeping him up out of the mud. 

The capacity of the solid surface of terra firma, 
under the perpetual paddle of feet or the grind of 
heels, for turning into a semi-liquid and churning 
itself into a sticky sea of bottomless mud is simply 
limitless and incredible — until seen or felt. 

The driest and firmest and most porous patch of 
the brown surface of Mother Earth only needs a little 
puddling during a steady rain to turn into a gummy, 
rubbery sponge which holds water as bread dough 
does gas, and which possesses a fiendish power of 
apparently eating its own way down into the depths. 

So, when a regiment sits down upon a particular 
plot of acres, and proceeds to make itself at home, 
the runways over which it passes backward and for- 
ward upon its lawful occasions rapidly turn them- 
selves into winding troughs of sticky glue, until the 
camp seems to be in danger of literally miring down. 



KEEPING THE CAMPS HEALTHY 263 

This is no mere figure of speech so far as man's 
faithful partner in warfare, the horse, is concerned. 
I talked with one French artillery officer, who was 
heartbroken over the sufferings of his poor horses. 
He said that during the winter it had been necessary, 
for military reasons, to keep them picketed or 
"stabled" in an open field, with no roof over them. 
The ground was fairly porous and well drained to 
start with. The horses were well fed and carefully 
blanketed so as to protect them as much as possible. 
But there was a steady succession of light, pelting 
rains, and under their constant stamping and shuf- 
fling, the ground beneath them steadily and relent- 
lessly churned itself into a bog of mud, first fetlock 
deep, then knee-deep, until they literally seemed to 
sink into the earth, and the hostlers would have to 
go round in the morning and pull some of the horses, 
which had been rash enough to attempt to lie down, 
out of the bog in which they were embedded. 

It was impossible to move the horse-lines, because 
this was the only patch of ground of sufficient size, 
within reach of the battery, which was protected from 
the enemy's fire. And my lieutenant, who evidently 
loved his horses as if they were his own children, said 
he never felt more relieved in his life than when at 
last the battery received orders to move and he could 
get his pets once more under a roof and with warm, 
dry bedding underneath them. 



264 THE DOCTOR IN WAR 

In the earlier days of the war, the condition of the 
men in the trenches was not so very distantly re- 
moved from that of the unfortunate artillery horses. 
They were literally up to their knees and often up to 
their hips in mud, not only in the trenches, but on 
the paths and roads they had to flounder along back 
to the camps and huts, and even between the huts 
themselves. 

But all this has long been changed for the better 
and largely got rid of; partly by greater skill and care 
in the surface drainage of the camps, partly by laying 
down solid paths, like little roads, with broken stone 
and ashes, and even empty tin cans, smashed flat, 
but chiefly by one very simple, but magnificently 
useful and effective, device, known as the "duck- 
walk" or "duck-board." 

These "duck- walks," to the honor of the New 
World be it said, are an American institution, intro- 
duced by the Canadian troops, and are nothing more 
nor less than the primitive grating or battened side- 
walks of the lumber-camps in the Big Woods, made 
of two pieces of two-by-four scantling, about sixteen 
inches apart, with battens of rough one-inch strips 
nailed across them, an inch or two apart. They are 
usually made in about eight-foot lengths, so that 
the sections can readily be picked up and carried 
to be laid wherever needed; and for all their sim- 
plicity, they are regular life-savers. The mud was 



KEEPING THE CAMPS HEALTHY 265 

not only extremely disagreeable and destructive to 
clothing, to say nothing of reducing the speed of all 
operations over the surface from fifty to seventy-five 
per cent, but it was extremely unhealthy. It worked 
its way through the boots and puttees and clothing 
of the men, and caused distressing irritations and 
inflammations of the skin; one form of which cul- 
minated in the dreaded "trench feet" or "trench 
gangrene." 

This was little to be wondered at, because sanitary 
arrangements are very difficult to carry out thor- 
oughly and scrupulously under almost incessant shell- 
fire. The mud could hardly be described as clean 
mud, as there were from five thousand to seven thou- 
sand men to each mile of trench, and in the earlier 
days of the war, when no one had any idea of its 
ghastly permanence, the dead had been buried pretty 
much where they fell, in some instances, under heavy 
fire, in niches scooped out in the walls of the trenches 
themselves. 

Not only did serious results come from the wet 
mud, but quantities of it, of course, dried on and 
stuck to the clothing or was tracked into the huts, 
where it turned to dust which both irritated the 
noses and throats of the men and greatly favored 
the breeding of fleas and other even more intimate 
parasites. 

Altogether, the soldier's grumbling about the mud, 



266 THE DOCTOR IN WAR 

which he regarded as a far more annoying enemy 
than the Kaiser and worse hardship than shell-fire, 
had abundant justification; it is literally a plague and 
pest, and the good influence which has been most 
powerful in exorcising it has been the blessed "duck- 
walk." It can be laid almost overnight; it will not 
sink into the ground, even in the boggiest spots, but 
half- floats, half-spraddles itself above the bog; it can 
be laid upon supports, thrown across the bottoms of 
the trenches and raised or lowered according to the 
ebb and flow of the slimy tide of mud. 

Crushed stone is excellent, if you have plenty of it, 
but short lengths of it will be literally buried under 
the tons of mud deposited on it by hundreds of 
hurrying feet, and no rain will wash it clean, while 
the "duck-board," by virtue of its porousness and 
lightness, is almost self-cleaning and comes up fresh 
and smiling after a shower. 

I was talking with a group of prominent officers of 
the Army Medical Corps — colonels of the Sanitary 
Staff — and the question happened to come up : 
which had been the greatest medical invention of the 
war? One said the anti-typhoid vaccine, another the 
Carrel treatment, the third, the "duck-boards"; and 
he pretty nearly succeeded in convincing the other 
two that he was right. 

I had equally convincing testimony from another 
point of view, in conversation with a prominent 




-: "** ' -1 '■ .;" *"'' ^v- '-•• • V>'V "*p. •■ . "' 



A STRETCHER-BEARER PARTY COMING THROUGH THE MUD 




A BRITISH TOMMY HELPING A GERMAN PRISONER CARRY A 
WOUNDED GERMAN THROUGH THE TRENCHES 



KEEPING THE CAMPS HEALTHY 267 

Army Engineer on the Western Front. After talking 
about the great variety and huge amounts of material 
required by a modern army, he asked me: "Now, 
what do you suppose, Doctor, is the most pressing 
need of the Army at present?" I guessed steel rails. 
"No," he said, "it isn't; it's crushed stone for the 
paths about the camps and the roads leading up to 
the trenches." 

Swift, safe, certain movement, in all weathers, 
whether of men, munitions, or food, or wounded, is 
the very life-blood of an army. 

The name " duck-board " seems to have been given 
to them in affectionate derision by the English troops 
because they resemble the little ladders or slatted 
boards laid for poultry to walk up to their houses 
or roosting-places, perhaps also in allusion to their 
web-footed and unsinkable qualities. The French 
troops, who have also adopted them, have an equally 
farmyard name for them, "caillebottis," which means 
curd-racks — the slatted racks on which curds drain- 
ing for cheese are placed in the dairies. 

Germs have their victories no less renowned in 
war than in peace. The soldier's worst enemy enlists 
with him, and the deadliest foe and the thing that 
kills most men in war is not bullets, but bugs and 
bacilli. Whenever you mobilize and call to the colors 
a thousand men, you call with them at least twenty 



268 THE DOCTOR IN WAR 

billion tubercle bacilli, ten billion typhoid, five billion 
pneumonia, and a couple of million each of the germs 
of measles, cerebro-spinal meningitis, diphtheria, and 
rheumatism. 

In other words, there will be twenty cases of half- 
healed, chronic or latent consumption, ten who have 
recovered from typhoid but are still "carriers" of the 
bacilli, five at least whose noses and throats are still 
swarming with pneumonia germs, and two each who 
still carry about with them odd, surviving colonies 
of the germs of measles, diphtheria, meningitis, and 
even mumps. 

The younger the soldiers the more certain you are 
of a full crop of these left-over germs, these "rem- 
nant" bugs which are eager to start a "bargain sale" 
spread whenever they are provided with plenty of 
fresh customers. 

An army assembles literally primed and loaded for 
trouble from the inside, ready to break out with 
epidemics, months before it ever comes within gun- 
shot of the enemy. And it invariably does break out 
unless the Sanitarian is sleeplessly on the job day and 
night. 

Five times as many soldiers, for instance, in our 
Spanish- American War, died of typhoid carried by 
flies from open latrines containing the feces of in- 
fected "typhoid-carriers" to unscreened food, as 
fell by Spanish bullets. Nearly twice as many Eng- 



KEEPING THE CAMPS HEALTHY 269 

lish soldiers died of the same disease, spread in the 
same manner, in the Boer War, as fell in battle. 

Just why and how there should occur this extra- 
ordinary explosion and expansion of disease among 
groups of healthy young men in the very prime of 
life, and from germs which they themselves are carry- 
ing about with them quite " unbeknownst" to them- 
selves, is something of a puzzle. We have, of course, 
a familiar parallel in the fierce epidemics of the same 
diseases which so often break out in boarding-schools, 
orphan asylums, convents, etc. It would almost 
seem as if a given strain of germs was able to adjust 
itself to a particular age of victim, and whenever, 
out of the thousands of lurking "carrier" germs in 
a large " one-age" group, one strain happened to be 
adjusted to that particular age, or became so after 
several trials, it would then run like wild-fire through 
the entire group, school, regiment, or mining-camp 
as the case may be; for our Western mining-camps 
have also furious epidemics of pneumonia and menin- 
gitis of this sort. 

In fact a curious apparent parallel exists in the 
plant world, as forestry experts have long found by 
bitter experience, that it is utterly unsafe to plant 
new areas in " solid " masses of one particular species 
of tree, because if a bacterial blight, canker, or other 
infectious disease gets a start anywhere in the young 
forest and gets " tuned " to the key of the species, it 



270 THE DOCTOR IN WAR 

will run through every last acre of it like a prairie 
fire. If, however, the young trees are planted in 
alternating bands or zones of different species, and 
the more widely different the better, then a dis- 
ease starting in any one of these is checked by the 
"strange" belt on either hand and can gather so 
little headway that it can easily be brought under 
control and stamped out. 

Whether this is the explanation or not, the annoy- 
ing fact remains that measles, mumps, diphtheria, 
and meningitis are the bane of the training-camps 
whether in France, in England, or at home in our 
cantonments; so much so that experienced com- 
manders distinctly prefer city and town bred recruits 
to country bred ones because they are far more likely 
to have had most of these minor pests in childhood. 
Indeed, the difference was strikingly illustrated in 
this war, for of all the various British troops it was 
the Australians, the New Zealanders, and the Cana- 
dians who suffered most severely from such "second 
childhood" attacks. The men were superb physical 
specimens, none finer in the whole Allied armies, 
but they simply had been born mostly in small vil- 
lages or towns and isolated bush settlements out in 
the open country and so escaped exposure to one 
or more of these plagues of childhood. In support 
of which theory it was the Newfoundland regiments 
which suffered most severely of all, while in the Eng- 



KEEPING THE CAMPS HEALTHY 271 

lish home armies it was the lads from the Orkney- 
Islands and the Hebrides archipelago who held the 
same unlucky distinction. 

Incidentally this is no argument whatever for hav- 
ing these diseases in childhood and " getting them 
over" while you're young. On the contrary, all 
these Colonies have among the lowest infant mortali- 
ties and childhood death-rates in the world, New 
Zealand the very lowest, 33 per 1000 births as against 
America's no and England's 120, while there is good 
reason to ascribe part of the superb physique and 
high average stature of these young recruits to their 
escape from the prostrating and chronic poisoning 
after-effects of these serious and much underestimated 
"little" diseases of childhood. 

The total net disadvantage of such escape is simply 
a little temporary annoyance to a few Army doctors 
and drill sergeants, and we can't inoculate the whole 
world just to suit their convenience; especially as we 
hope it will never be necessary again, at least in our 
lifetime, and won't be when we get all the Boche 
Beast's teeth drawn. 

The actual effects of these belated children's dis- 
eases in training-camps, although very annoying, are 
usually comparatively slight and temporary, with 
the exception of meningitis and diphtheria. 

But they seriously interfere with training, occa- 
sionally assume very severe and even fatal forms, and 



272 THE DOCTOR IN WAR 

if allowed to spread unchecked would unquestionably 
result in the disabling for months, and even years, 
of a considerable number of fine young soldiers. Even 
when promptly recovered from, they often leave the 
bronchial tubes, heart, and kidneys in a weakened, 
irritable condition for months afterwards, or are fol- 
lowed by secondary pneumonias of great severity, as 
painfully illustrated in our cantonments last winter 
and during the influenza plague this fall. 

The only protection against them is ceaseless 
watchfulness on the part of the regimental surgeons, 
to detect and isolate the very first cases at the earliest 
possible moment. One of the first sanitary require- 
ments of a camp nowadays is an isolation ward or 
small hospital for all cases showing any signs or even 
suspicious symptoms of any sort of infection, includ- 
ing "common colds": " tonsillitis wards" as they 
are called. 

If diphtheria appears, in addition to isolation of 
patients, preventive doses of anti-toxin are given 
to all whom they have come in contact with, and 
everybody's throat is examined and "swabbed" for 
bacteriological examination to detect "carriers" of 
the germs. Then they, too, are isolated till their 
throats are cleaned up by sprays and anti-toxin. It 
is not necessary to give anti-toxin to those who give 
a clear history of a previous attack or who react to 
a skin test or "vaccination " known as the Schick test. 



KEEPING THE CAMPS HEALTHY 273 

Measles, though less directly serious, is very diffi- 
cult to check, because its most infectious stage is 
before the patient shows any signs of disease or even 
feels sick. Indeed, the recently claimed germ of the 
disease has disappeared entirely from the patient's 
body before the rash breaks out. 

Fortunately, however, one of our American Army 
sanitarians has discovered that the germ is quickly 
killed by direct sunlight, and if all the bedding, 
clothing, and entire kit of the recruits are spread out 
in the hot sun every day for two or three days in suc- 
cession, the further spread of the disease is usually 
promptly checked. 

The most serious alarm of all was caused by the 
series of small epidemics of cerebro-spinal meningitis 
("spotted fever") which occurred among the Ca- 
nadian and other Colonial troops in their training- 
camps in England early in the war and as soon as 
we came into the war in our cantonments at home. 
In this case it was doubtful whether the infection 
was brought by the troops, or whether it was caught 
from the surrounding civilian population, with the 
balance of evidence in favor of the latter source. 

The disease proved extremely obstinate and diffi- 
cult to stamp out, and though by the vigilance of the 
Army sanitarians the total cases were kept down to 
a few hundreds and the deaths to a few score, yet it 
was a hard, troublesome long-drawn-out fight to 



274 THE DOCTOR IN WAR 

clean it up altogether, and the end was only reached 
a few months ago. The most effective means of pre- 
venting it was found to be antiseptic sprays of thymol 
or dichloramin in the noses and throats of all "sus- 
pects," " carriers,' ' and "contacts"; that is, all who 
had carried the germs of, or had come in contact 
with, the disease: for epidemic meningitis enters the 
system through the nose and is spread by sneezing 
and coughing. 

Of course, from the deadliest plague and heaviest 
curse of army camps, typhoid, our troops have been 
completely and triumphantly delivered in this war 
by the anti-typhoid vaccine. 



XVI 

THE PROBLEM OF TUBERCULOSIS 

AT first sight scarcely any two things could be 
more strikingly different and diametrically op- 
posed to each other than war and consumption. As 
a mode of death the one is swift, vivid, dramatic; the 
other, slow, feeble, colorless. It was the proud ambi- 
tion of all the old fighting men of song and story to 
die in battle, "with their boots on," and their great- 
est dread and horror was "a straw death," a feather- 
bed end, after a lingering decline. 

The warrior and the consumptive are just about 
at the opposite poles of human possibilities. Yet up 
to thirty years ago the warrior who enlisted for a long 
war had about twice the chance of dying of consump- 
i tion that he had of falling on the field of battle, and 
to this day the commonest cause of death among 
"armies in barracks is tuberculosis. 

The reason for this rather surprising and half- 
incredible state of affairs is a fairly simple one. It is 
along the line of the old Latin saw about Caelum 
non animum mutant ; we can change our climate, but 
not our disposition, or, in modern terms, our outside 
habits, but not our inside bugs. 

Ninety per cent of us are "loaded" with the tuber- 



276 THE DOCTOR IN WAR 

cle bacillus from our childhood days — one or more 
slumbering colonies of him tucked away in some part 
of our internal anatomy. Whenever we become suffi- 
ciently depressed, and out of sorts from any cause, 
to soften and weaken the wall that imprisons him, 
out he comes ready for war. 

Whenever the food-supply of the soldier becomes 
bad or scanty, when his water becomes foul or his 
sleeping-places verminous, when he is crowded and 
packed into winter quarters in caves dug in the hill- 
sides or in shacks covered with earth, when he has 
wasted away from the hectic fever and heavy sup- 
puration of festering wounds, then the tubercle bacil- 
lus claims him as its own and carries him off, just 
as it would a half-starved sweat-shop worker in an 
attic or an overworked slavey in a cellar kitchen. 

In the sixteenth and seventeenth centuries gallop- 
ing consumption and tuberculous pneumonia were 
high among the plagues which melted away troops 
in their winter encampments faster than the on- 
slaughts of the enemy could in the field. 

So, when this war broke out and began to assume 
its underground character, with the troops half- 
buried in the trenches all day and completely so in 
dug-outs and cellars and underground shelters at 
night, sanitary experts were quite prepared to expect 
a serious and widespread outbreak of tuberculosis 
in their ranks. But for the first two years of the war 



THE PROBLEM OF TUBERCULOSIS 277 

they were most agreeably disappointed; instead of 
the troops in the field showing more tuberculosis 
than in previous open or aboveground wars or in 
civil life, they actually showed far less. Indeed, the 
general health of the soldiers in the field was better 
and their disease and death-rate less than the average 
of soldiers in barracks before the war. With certain 
exceptions which will be discussed later, our success 
against tuberculosis has been almost as complete in 
this war as it has against typhoid, typhus, diarrhoea, 
dysentery, and cholera. 

This gratifying result seems to have depended 
largely upon two things — food, and protection from 
other, even slight infections. The tubercle bacillus, 
like the poor, we have always with us, and when- 
ever he can he will do us ill, but the two things 
that give him the best and most favorable openings 
are starvation and other infections, notably typhoid, 
measles, and common colds. From both of these 
wicked partners the superb food-supply of our armies 
in the field, and the relentless and successful fight 
waged by the Sanitary Corps against all infections 
of every sort, big and little, have protected our armies 
in Flanders more perfectly, probably, than any like 
body of men was ever protected before. 

The one unfavorable influence — the half-under- 
ground character of the fighting and the poorly ven- 
tilated and lighted sleeping-places that the soldier 



278 THE DOCTOR IN WAR 

has been compelled to occupy both in the fighting 
line and reserve — appears to have been completely 
neutralized, partly by the rich and abundant food, 
and partly by the merciful fact that when strong, 
vigorous men in the prime of life spend the greater 
part of their working hours in active exercise in the 
open air, they seem to be able to consume their own 
smoke at night and sleep in almost any kind of a 
cave or kennel, for some time, at least, without obvi- 
ous damage. As, for instance, Banks fishermen, who 
literally choke the lamp out by exhausting the oxygen 
on stormy nights in their air-tight fo'castle, and 
farmers whose bedroom windows are hermetically 
sealed all winter. 

Not only has there been no new development of 
tuberculosis in healthy soldiers under the strains and 
hardships of war, but many even known to be tuber- 
culous before enlistment or conscription have gained 
weight, improved in health, and made active and 
useful soldiers. 

Burnand declares that many tuberculous patients 
actually escaped from French sanatoria and enlisted, 
and that the majority of them kept up well and ren- 
dered excellent service. 

Faginoli reports that many Italian and Austrian 
consumptives in the incipient stage went to the Front 
and were greatly improved by active service. 

Banks traced forty-eight known cases, most of 



THE PROBLEM OF TUBERCULOSIS 279 

them former sanatorium cases, who were accepted 
by the English Draft Boards, and nineteen of them 
were sent into active service, and out of the whole 
number only one broke down ! 

In Osier's opinion the number of latent tubercu- 
lous who broke down in military service was less than 
might have been expected if they had remained in 
civil life. 

Fishberg, after a careful and thorough study of the 
literature of all the warring countries, concludes that 
the morbidity and mortality from tuberculosis among 
the belligerent nations has not increased during the 
war. 

Renon in France declares that there was no in-( 
crease of tuberculosis either in the Army or among 
the civil population during the first three years of 
the war. 

And all authorities are agreed that such tubercu- 
losis as does occur among the soldiers is invariably 
the reactivation of an old focus, the awakening of a 
dormant infection, which existed long before the 
war, as clearly shown by the histories. 

General Turner told me personally that he had 
known numbers of men with old healed or dormant 
tuberculosis who had entered the Army and gained 
weight and strength, as if they had taken an open- 
air course. 

The one element of the diet which has probably 



28o THE DOCTOR IN WAR 

contributed most to this splendid showing against 
the tuberculosis devil and all his works has been the 
abundance of meat. Everywhere one goes along all 
the Fronts, one is struck by the fact that meat in 
some form appears upon the mess-tables and in the 
ration- tins at almost every meal, bacon or ham or 
hash for breakfast, roast meat for dinner, and cold 
meat, ragouts, goulashes, and other meat stews with 
vegetables for supper. 

On the clay flats of Flanders, on the rolling hills of 
the Somme, on the green mountains of Alsace, and 
along the Alpine ridges of the Italian front, when the 
rationing parties began to distribute their burden to 
the men in the trenches, I found the leading dish 
always a generous can of hot, savory, comforting 
meat stew, for each Tommy, Poilu, Yank, or Alpini. 
And the men simply thrive on it. 

Never has there been a more convincing refutation, 
upon a larger scale, of the silly old superstition that 
meat is merely a luxury, that we should be healthier 
without it, and that its extensive use is followed by 
all sorts of maladies and mischiefs. Seven million 
men on the Western Fronts have now for more than 
two years had almost all the meat they could eat, at 
least twice and often three times a day, and the 
special diseases and disasters which were supposed 
to be caused or aggravated by meat-eating — gout, 
rheumatism, arterio-sclerosis, Bright's disease, liver 



THE PROBLEM OF TUBERCULOSIS 281 

trouble, and paralysis — have been strikingly con- 
spicuous by their absence. 

The only exceptions which could even be claimed 
by the "meatophobes" are a curious type of mild 
inflammation of the kidneys, known as trench 
nephritis, which is now practically proved to be due* 
to other causes, and an increase noted by some 
Army surgeons of irritability of the skin and a ten- 
dency to dermatitis. But the skin irritability has a 
way of almost entirely disappearing under the simple 
remedy of two hot shower baths a week instead of 
X)ne. 

Everywhere you go along the lines the armies are 
simply radiant with health and vigor, with spirits to 
match, and if a liberal meat diet could produce one 
fifth of the evil consequences which many of our dieti- 
tians, both lay and medical, so confidently ascribe 
to it, they would surely have begun to show them- 
selves somewhere, in some measure, before this time. 

In an army, as in a nation, vigor, both physical and 
mental, and progressiveness run in proportion to the 
amount of meat consumed per capita up to ninety 
pounds per annum. The only reason under Heaven 
why any nation, or class in a nation, does not eat 
abundance of meat, at least twice a day, is that it 
can't get it, either on account of poverty or lack of 
intelligence. The healthiest and most vigorous rice- 
eating or potato-eating or cassava- or banana-eating 



282 THE DOCTOR IN WAR 

nation in the world can be "fed up" to thirty to 
fifty per cent higher working power and healthf ulness 
by a liberal addition of meat to their diet. 

What is more to the point in the present instance, 
the widespread colonial experience of both England 
and France with native troops has shown overwhelm- 
ingly that almost any tribe or race of black, brown, 
red, or yellow varieties of the genus humanum can be 
made into first-class fighting men by feeding upon 
even an approach to European army rations, con- 
taining meat, fat, and wheat bread. 

The next important anti-consumption element in 
the Army ration has been the liberal supply of good 
bread. Not only has the Army bread-ration been 
liberal to the point of extravagance, but the quality 
of the bread is much better than that supplied to the 
civil population. This I found to be the case on prac- 
tically every Front that I visited, and other observers 
with whom I have talked give the same experience. 
Indeed, outspoken and unhesitating testimony to this 
effect is volunteered by almost every Tommy who 
comes home on leave, or poilu on "permission." This 
is due, in part, to the fact that the Army bakers and 
cooks, under the watchful supervision of the Medical, 
Sanitary, and Army Service officers, do their bread- 
making more intelligently and carefully. But most 
of it is due to a lower percentage of bran and other 
indigestible husks in the flour. 



THE PROBLEM OF TUBERCULOSIS 283 

A considerable amount of the Army flour has been 
bought by contract abroad, and hence is of the civil- 
ized or white variety. And this, when mixed with 
the eighty-five per cent war-bread flour, has miti- 
gated its indigestibility. In several places I found 
that the Army bakers, having their bread-ration 
issued to them in the shape of flour, were deliberately 
sifting or bolting it before making it into bread, so as 
to remove a considerable percentage of the surplus 
bran. They told me the rather curious and unex- 
pected fact, that by doing this and sifting out the 
branny particles, they could get more loaves of bread 
to the hundred pounds of flour than by using the 
whole, unsifted flour. So that it went just as far, 
and the men liked it very much better. 

Indeed, the experience of the Army is beginning to 
raise a doubt in the minds of thoughtful supply ex- 
perts and Army doctors as to the real and funda- 
mental economy of the eighty -five per cent war- 
bread flour. One half of the eight per cent saving 
supposed to be effected by it is known to consist of 
fragments of the husk of the wheat berry, which are 
entirely indigestible in the human stomach. As these 
fragments are not only incapable of assimilation, but 
set up an irritation in the stomach and intestines, 
with or without diarrhoea, which sweeps away more 
than their own bulk of the digestible elements of the 
flour unutilized, it is an open question whether the 



284 THE DOCTOR IN WAR 

saving supposed to be effected by their retention is 
not a fallacious one. 

It would be very helpful to have careful experi- 
mental tests made upon squads of students or sol- 
diers or other volunteers to see whether this saving 
is a real or an imaginary one, and also to test whether, 
if a given amount of eighty-five per cent flour were 
sifted before being made into bread, more loaves of 
the latter would be eaten per week than of the un- 
sifted flour. Our American experience has shown that 
it is better and wholesomer to sift out most of the 
bran and middling, and then dilute this white (sev- 
enty to seventy-five per cent) flour, with the desired 
proportion, usually about twenty-five per cent, of 
substitute flours from barley, rice, or corn. 

The third element of importance in the soldier's 
diet in keeping up his superb health and high degree 
of resistance against disease has been the sugars 
and their recognition as a real food. In every Army 
ration, on every mess-table, on the three Western 
Fronts, sugar in some form — fruits, dried, canned, or 
preserved, or syrup — has been made a regular and 
substantial feature. 

The craving, gnawing sense of hunger for some- 
thing sweet which comes over a man after two or 
three weeks of the old-style Army or lumber-camp 
or cow-camp dry ration, is not only almost irresisti- 
ble, but a sound and wholesome instinct. The first 



THE PROBLEM OF TUBERCULOSIS 285 

and most intense craving of our cowboys, our lumber- 
jacks, and our miners, when they come down to the 
little frontier towns, is for canned peaches and pie 
and sweet cake, their second for whiskey. 

There can be no question that the remarkable 
sobriety of the huge armies of this war, the rarity of 
alcoholic excess among our soldiers, has been closely 
connected with the abundant and varied supplies 
of that other "readily assimilable carbohydrate," 
sugar, either straight or in the form of dried fruits, 
preserves, biscuits, or syrup, in the ration. And the 
keenest craving of our boys on coming out of the 
trenches is for chocolate, doughnuts and pie, in pro- 
viding which, at whatever risk, the Y.M.C.A. sec- 
retaries and Salvation Army lasses are winning their 
way swiftly right to the heart of the army. 

A partial exception to this general sweep of tri- 
umph over tuberculosis would appear to be the 
French Army, in which, particularly within the last 
year or year and a half, a considerable number of 
cases of tuberculosis have been reported. The num- 
bers have been variously estimated at from fifty 
thousand to one hundred thousand cases, — Armand 
de Lille, who speaks with authority, says eighty-five 
thousand, — but while these figures look large in the 
mass and taken alone, when they are placed against 
a background of nearly six million men and figured 
out on a percentage basis, they show only about the 



286 THE DOCTOR IN WAR 

figure which might be expected of men of these ages 
in civil life in time of peace. Even the larger estimate 
would figure out only about one and a half per cent, 
while the frequency of tuberculosis in industrial life 
at military ages is believed to be between two and 
three per cent. The only reason why tuberculosis 
in the French Army attracts attention is that all 
the soldiers have been kept under constant medical 
observation and every case reported and dealt with, 
either by discharge or by treatment in a sanatorium, 
so that the whole world is made aware of it. A similar 
study of the same number of men in peaceful pursuits 
in any one of the neutral countries, for instance, 
would probably have uncovered quite as many cases 
of tuberculosis, only, as the old proverb has it, 
" What you don 't know does n't worry you." 

An excellent and well-arranged system of special 
hospitals and sanatoria for tuberculous soldiers has 
been planned by the French Government, and an 
important division of the American Red Cross, backed 
by the Rockefeller Institute, is cooperating with them 
splendidly in giving these stricken defenders of their 
country every possible attention and chance of cure. 

A genuine exception to the general rule is among 
the French prisoners in the German prison camps, 
who appear to be showing a high rate of tuberculo- 
sis, due to their wretched diet and cruel and disab- 
ling treatment, deliberately planned to break down 



THE PROBLEM OF TUBERCULOSIS 287 

their health and destroy their future fighting power. 
Also the unfortunate inhabitants of some of the war 
zones just behind the Western Front. By the steady 
and ruthless policy of constant and indiscriminate 
bombardment of everything that their guns or air- 
planes can reach, particularly with gas-shells, the 
Germans have driven tens of thousands of these un- 
fortunate people to live a considerable part of their 
day and the whole of the night in cellars and caves 
and underground shelters : with the result — which 
need surprise no one — that examinations made by 
various civilian relief organizations of the women and 
children of these regions show an appalling amount 
of tuberculosis, ranging in some instances from forty 
to sixty per cent of those examined. But this, of 
course, is only a part of the general policy, openly 
avowed by the German commanders, that they are 
making war, not only upon the French Army, but 
upon the entire French nation, men, women, and 
children. 

Curiously enough, such civil statistics as are avail- 
able in France seem to show that in the mass of the 
country, taking Paris as an example, there has been 
not only no increase in deaths from consumption, 
but an apparent decrease. In Paris, for instance, ac- 
cording to the reports, there has been a diminution 
in both the total number, and proportion per thou- 
sand living, of nearly ten per cent between 19 13 and 



288 THE DOCTOR IN WAR 

19 1 6. While, of course, too much confidence cannot 
be attached to these figures, on account of the tre- 
mendous fluctuations of both population and propor- 
tions of various age classes, yet it is in keeping with 
the general death-rate, which shows a similar decline, 
as reported, of about six per cent. 

One of the most consoling features of this terrible 
war has been the way in which, on account of its 
being waged chiefly by machinery, elaborate mechan- 
ical contrivances, and munitions, it has, instead of 
diminishing industrial activity and output, increased 
it, and has provided abundant occupation and higher 
wages than ever before known for practically every 
man, woman, or child of the civil population who is 
able to work. So that the masses of the people — 
and this is true not only of England, but of France 
and Italy — have far more money to spend, and are 
consequently better fed, better housed, and better 
clothed than ever before in history. 

After rather careful and fairly extensive observa- 
tion, I can say that I saw no signs of injurious food 
scarcity or of underfeeding in any part or in any class 
of England, France, or Italy. Food is high, but wages 
are higher. 

There has always been a considerable amount of 
tuberculosis in Northern and Northeastern France 
in the coal-mining and industrial populations, though 
no higher than in similar regions in Germany and 



THE PROBLEM OF TUBERCULOSIS 289 

other European countries. So that hundreds of thou- 
sands of soldiers must have entered her armies carry- 
ing dormant foci or smouldering embers of partially 
healed tuberculosis in their lungs or glands. There 
was no time to make elaborate medical examina- 
tions; every man able to shoulder a rifle and march 
a couple of miles had to be flung into the ranks to 
stop the onrush of the Beast and save civilization 
from the Hun. 

^ A considerable number of these men in the milder 
forms and earlier stages of the disease were stimu- 
lated and built up by the outdoor life and good feed- 
ing and secured a cure, or at least long-continued 
arrest, of the disease. Another moiety were tempo- 
rarily improved, but were unable to bear up under 
the long-continued strain of the hardships and dis- 
comforts of the trenches, so that, about the close of 
the second year of the war, they began to break down 
and develop a relapse of their ancient trouble, and 
the Army Medical Boards, having had time to get 
their breath and complete their organization, started 
on a thorough investigation of all the "reformed," as 
the French call those who are invalided out of the 
Army, and naturally discovered a considerable num- 
ber of these war-strain tuberculoses. 

They faced the situation with admirable prompt- 
ness and intelligence. An excellent system of both 
tuberculosis hospitals and open-air rest-stations for 



290 THE DOCTOR IN WAR 

the consumptive "reform6s," was organized and 
equipped, one for each of the larger departments of 
France, and provision was made for special care and 
feeding for the graduates from these institutions 
after they had returned to their homes. 

But, of course, this all meant publicity, and the 
German propagandists and sympathizers all over the 
world, particularly in America and Switzerland, 
and the " Defeatists" in France, fairly leaped at the 
chance and filled the press and the air with the wild- 
est rumors and most unprincipled falsifications. The 
French Army was simply melting away with tuber- 
culosis, a quarter of a million, half a million, a million 
cases had already been discovered, and at least as 
many more unrecognized cases were in the ranks. 
The real and innate decadence of the French nation 
had at last revealed itself, ran the canards, and if the 
war lasted for two years more the country would be 
depopulated by tuberculosis ! 

Unfortunately, some of the friendly medical ex- 
perts from the Allied countries, who visited France 
to see how they could best assist her in her campaign 
against the disease, reported that the condition was a 
serious one in certain regions and industries, and this 
again was eagerly seized upon and unscrupulously 
exaggerated by the enemy. 

But the French authorities kept their heads, calmly 
went on with their well-laid plans, accepted cour- 



THE PROBLEM OF TUBERCULOSIS 291 

teously and gratefully the proffered assistance from 
their Allies, and proceeded to make the widespread 
interest and deep concern over the ravages of tuber- 
culosis, stirred up by the war and its developments, 
the basis and excuse for a broad, magnificently con- 
ceived, nation-wide campaign of education and pre- 
vention against this dread disease. 

Several of the provincial cities of France, notably 
in the Department of the Loire, had established 
before the war admirable systems for dealing with 
tuberculosis, consisting of dispensaries, children's 
clinics, open-air schools, open-air sanatoria for the 
curable, and hospitals for the advanced cases of con- 
sumption. The organization of the Department of 
the Loire excited the admiration of all the English 
and American tuberculosis experts who visited it. 
It had nine tuberculosis dispensaries, a sanatorium 
with four hundred beds, and a model farm attached 
to it, an open-air country school for children, two 
hospitals for consumptives, and a training-school for 
tuberculosis nurses. 

This is to be taken as a model by the Minister of 
the Interior, and similar systems are to be developed 
in at least half of the larger provinces and depart- 
ments of France, which will be linked up with the 
sanatoria and the hospitals for soldiers discharged 
from the Army on account of tuberculosis. As a 
result, by the close of the war, the French will have 



2 9 2 THE DOCTOR IN WAR 

a chain of these sanatoria and hospitals all over the 
country, linked up with the local dispensaries and 
hospitals and the children's clinics, which will be 
adequate to provide for the needs of the entire civil- 
ian population. In consequence, there will, within a 
very few years, be far less tuberculosis in France than 
there was before the war, and it will be quite possible 
within twenty years to save almost as many lives 
from tuberculosis as have been so deplorably sacrificed 
on the battlefield to the Hun greed for conquest. Our 
American Red Cross and a special commission of 
some of the most skilled and competent experts in 
tuberculosis, supported by the Rockefeller Founda- 
tion, are most liberally and helpfully collaborating 
with the French authorities in this magnificent work. 
And just recently they have equipped and sent out 
a similar commission to conduct a campaign against 
tuberculosis in Italy. So that war is not quite all 
hell. 



XVII 

THE PLAGUES OF ARMIES 

TWO great plagues have ever swept close in the 
wake of war — drunkenness and venereal dis- 
eases. Mars, Venus, and Bacchus have always been 
closely grouped together since the days of the old 
mythologies. From one point of view, their impor- 
tance has been usually exaggerated and overesti- 
mated; as destroyers of life and decimators of peo- 
ples they are among the feeblest and most trivial of 
the pestilences that riot in the soil turned up by 
the war plough. 

Typhus and typhoid killed at least a hundredfold 
as many as both drunkenness and dissipation ; malaria 
and pneumonia each fifty times as many; the little 
bugs that get into the wounds and cause septic or 
surgical infection were at least ten times as deadly. 
The main reasons why these twin plagues stand out 
in such bold and vivid relief among the evils of war 
is, first of all, their dramatic and striking character; 
second, that they are due to factors which are under 
the control of the individual sufferer; and, third, that 
they continue to curse and vex not only the com- 
munity after the war is over, but future generations 
as well. The soldier who dies of typhus or typhoid 



294 THE DOCTOR IN WAR 

in the tented camp, or of gas-gangrene or septic infec- 
tion in the field hospital, has incurred not the slight- 
est element of blame or reproach; on the contrary, 
he has bravely risked and lost his life facing the risks 
and horrors of the war, and his memory is revered as 
that of a hero and a true patriot. But the soldier 
who comes home from the war with a habit of alco- 
holic excess fixed upon him, or with the infection of 
one of the venereal diseases which he proceeds to 
spread through the community and to pass on to his 
helpless children, is a living shame and a perpetual 
menace and burden to his family, his friends, and his 
country. 

This present war, terrible and world-wide as it is, 
and destructive upon a scale never before known in 
history, has shown certain remarkable redeeming 
features which strengthen the hope of its ushering 
in a new and higher type of civilization, a lasting vic- 
tory of humanity over the beast. High among these 
stands its wonderful success in dealing with and pre- 
venting disease. Typhoid has been almost wiped 
out by the anti- typhoid vaccine; typhus, wherever it 
showed itself, stamped out by destruction of the 
vermin which alone carry it; dysentery and diarrhoea, 
reduced to the vanishing point by fly-fighting, scru- 
pulous purification of water, and protection of food- 
supplies; tetanus (lockjaw), prevented by the routine 
use of the anti-toxin; and surgical skill saves ninety 



THE PLAGUES OF ARMIES 295 

to ninety-five per cent of all the wounded who sur- 
vive six hours. 

Why should not drunkenness and syphilis follow 
suit with the other diseases and be wiped out as well? 
There is no reason whatever why they should not if 
we fight them as vigorously, as intelligently, and as 
openly as we have typhus and typhoid and tetanus. 
Indeed, the first of these two Unheavenly Twins has 
been most successfully attacked already. Not only 
has the world never seen an army so free from dis- 
ease as the one under arms at present, but also it has 
never seen an army in the field so sober and so free 
from disorder and crime. 

The unexpected has happened by an almost in- 
credible paradox. Instead of the world having be- 
come more drunken in time of war, it has become 
distinctly and strikingly more sober. More progress 
has been made toward the lifting of the curse of 
drunkenness, in Russia, in France, in England, in 
three years of this war than in any twenty preceding, 
and now the United States has swung into line by 
the vote in Congress to stop, in 1919, the manufac- 
ture and sale of alcoholic beverages during the war, as 
a means of saving valuable grain for our food-supply. 
By a curious coincidence, which is anything but ac- 
cidental, the Central Powers are as barbaric and as 
reactionary upon this issue as upon all the others 
involved in the war. 



296 THE DOCTOR IN WAR 

The German Army must have its beer regularly 
just the same as the rest of its supplies, and in liberal 
quantities, and the quarters where a German officers' 
mess has been located can always be recognized by 
the piles and heaps of empty wine and beer bottles 
which surround it. Which accounts for part of the 
bestial conduct of all ranks toward the unfortunate 
captives that fall into their power, particularly 
women and children. 

It is one of the most astonishing and encouraging 
features of this war that you can walk for hours in 
the afternoon, evening, and till late at night, through 
the streets of English cities, or French villages, fairly 
swarming with soldiers, French, English, Canadian, 
Australian, Russian, Italian, Moroccan, and never 
see a drunken or quarrelsome soldier. Here and there 
you will come across one who is a trifle exalted and 
anxious to explain to an admiring public what a fine 
fellow he is and what a splendid regiment or country 
he belongs to. But even he is a rare exception and is 
always under the anxious and parental care of at 
least three or four of his comrades, who are trying to 
keep him quiet and to get him home to his quarters 
as quickly as possible. To be seen drunk in public is 
evidently regarded as both very bad form for the in- 
dividual and reflects discreditably upon the regiment. 
This natural tendency of the soldier toward restraint 
and self-respect has been greatly helped by the most 



THE PLAGUES OF ARMIES 297 

sensible provision in both England and France, mak- 
ing it a punishable offense to offer a drink of any kind 
of alcoholic beverage to a soldier or sailor in uniform, 
in any public place. 

What is even more incredible, in London, in war- 
time, crime has fallen to far the lowest level that has 
ever been known since records have been kept! And 
this with the streets swarming with hot-blooded, 
adventurous young fellows, not only from every cor- 
ner of the United Kingdom, but from every quarter 
of the world, many of them back, for a week's leave 
and breathing spell, from a bloody and dangerous 
battle front, and anxious to get the utmost pleasure 
and relief possible from the stern privations they are 
going back to, and those streets in more than semi- 
darkness all night long. 

This new standard of the Army has had a great 
influence upon that of the general public — partly 
because so many men are in the Army, and partly 
because of the admiration of everything military 
which develops in war-time. As a result, combined 
with higher wages and better living conditions, the 
amount of alcoholic excess, as measured by the arrests 
for drunkenness, has fallen off sixty per cent since 
the beginning of the war. Lord D'Abernon's latest 
report, as Chairman of the Liquor Traffic Board, 
declares that drinking in England has diminished 
eighty-five per cent! 



298 THE DOCTOR IN WAR 

So that venereal disease is the only one of the 
plagues of war which lags behind, and already a most 
encouraging beginning has been made against that. 
The movement had started some two or three years 
before the war, partly as the result of the general 
awakening and enlightenment of the public health 
conscience; partly, and even more powerfully, be- 
cause for the first time in history we found ourselves 
in possession of a remedy which would not only cure 
the disease within a reasonable length of time, but, 
what was more important, would make the patient 
practically safe, and harmless, as a further source 
of infection, within a few days. This was the now 
famous "606" or salvarsan, as its name implies, an 
ingenious combination of arsenic. 

This wonderful boon will cure, roughly speaking, 
eighty per cent of all cases of syphilis in from three 
to five months, and, what is far more valuable from 
a preventive point of view, clears the spirochetes or 
germs of the disease out of the blood within forty- 
eight hours of the first injection I This disappearance 
is not permanent, as a fresh crop of the germs will 
reappear in a month or* so, from seed-germs which 
have taken refuge from the poison in the deeper parts 
of the body, probably the glands and the marrow of 
the bones. But it means that if the victim of syphilis 
is promptly discovered and treated with salvarsan 
and then kept under observation at monthly inter- 



THE PLAGUES OF ARMIES 299 

vals, nine tenths of the risks of his spreading the disease 
will be wiped out I 

Incidentally, this is jtist as much for the advantage 
of the patient as it is for that of the community, be- 
cause the rapid destruction of the spirochetes by sal- 
varsan not merely stops his infectiousness to others, 
but also prevents the further development of the dis- 
ease. So that, in the majority of cases, the dreaded 
rash and ulcers in the throat, and the falling of the 
hair and destruction of the bones and involvement of 
the nervous system (locomotor ataxia, paresis, etc.) 
are completely prevented. It is hardly too much to 
say that the patient who discovers that he has been 
infected within a month or even two months of his 
exposure, and takes salvarsan, will, eight times out 
of ten, never know that he has had syphilis. 

Naturally this encouraged health authorities and 
physicians to move actively for the prompt recogni- 
tion and reporting of all cases of syphilis, with public 
provision for its treatment, if necessary, without 
expense. One of the ablest and most careful studies 
of the question was that made by the English Royal 
Commission on Venereal Disease appointed in 19 13, 
just a year before the war. After studying the prob- 
lem very thoroughly and intelligently for two years, 
it was ready to report, but hesitated for some time 
because, the war being then in full swing, it feared 
that either little attention would be paid to the report, 



300 THE DOCTOR IN WAR 

or that nothing could be done to put in force its 
recommendations. 

However, in the second year of the war it decided 
to risk it, and much to every one's surprise and 
gratification, it found both the public and the civil 
and military authorities in a most receptive frame of 
mind. Most of its practical recommendations were 
adopted at once, without waiting for the action of 
Parliament, where bills were introduced in both 
Houses to improve the laws dealing with the situation. 

Now the health authorities and officials of all parts 
of England are prepared to offer to any persons who 
suspect that they may have become infected with 
syphilis, first, a free examination of their blood, by 
the Wasserman test, or the Noguchi test, which will 
determine positively whether they have syphilis or 
not; second, if the infection is found to be present, 
free treatment with salvarsan by competent experts 
for as long as may be necessary to complete the cure, 
and without expense to the patient. 

A similar arrangement has been established by the 
Health Department of New York City, for four years 
past, and is giving admirable results. Or was, until 
the New York County Medical Society, to its lasting 
shame, rose up in wrath and demanded that the free 
treatment be stopped, because it was taking money 
out of the pockets of the doctors — or, as they put it, 
the bread out of the mouths of their families! 



THE PLAGUES OF ARMIES 301 

Much, of course, remains to be done, principally 
in three directions: First, education of the public, 
and particularly of the young, including a new stand- 
ard of biological morality; second, making the matter 
first and foremost a public health problem, and get- 
ting rid, as far as possible, of the sense of disgrace 
arid special culpability and concealment about the 
misfortune; third, dealing with the prostitute as a 
clearly mentally defective class and a permanent 
menace to the community. 

The first of these aims — education — is rapidly 
being attained; one of the most valuable and unex- 
pected results of the report of the English Royal 
Commission was the full, thorough, and sensible dis- 
cussion of it which was given in all the daily papers. 
Not only was the majority of the report published in 
full, but editorial after editorial appeared in the most 
sacred columns, calling attention to the dangers of 
neglect and delay, and even mentioning syphilis right 
out by name in public — which was little short of a 
miracle, considering the traditional attitude of both 
the British public and the British press upon this 
subject. And after some hesitation the Army authori- 
ties took up the problem in the training-camps in the 
same spirit, with most gratifying results. Talks were 
given, first by the Army doctors and then by special 
medical lecturers who volunteered their services, 
clearly and frankly describing the nature and risks of 



302 THE DOCTOR IN WAR 

syphilis and gonorrhoea, and the means of their pre- 
vention, with special emphasis upon the fact that 
sexual indulgence is not in the least necessary to 
health, and that the greatest menace of such illicit 
pleasure is to the welfare of the next generation. 

The importance of this victory over stupidity and 
nasty-mindedness, calling itself modesty, can hardly 
be overestimated: first, because the judgment of 
average humanity is surprisingly sound and sensible 
when once it has the proper knowledge on which to 
base it; second, because the young are cleaner- 
minded and more decent and sensible about these 
matters than the middle-aged and the old, popular 
delusions to the contrary notwithstanding. 

If we would stop preaching at our boys and girls 
about these matters, simply tell them the facts and 
let them form their own conclusions as to the wisest 
and most honorable course, we should get far better 
results. The dangers of the adolescent period have 
been enormously exaggerated, and our hysterical 
descriptions to boys and young men of the terrible 
temptations and fierce struggles with their instincts, 
which they are sure to experience if they attempt to 
behave themselves decently and sensibly, do far more 
harm than good. It is distinctly doubtful whether 
adolescence is the period of severest temptation in 
this regard; that is to say, in proportion to the 
deterrent and counter-balancing influences. Cer- 



THE PLAGUES OF ARMIES 303 

tainly the large majority of those who are brought 
before our courts of justice for sexual offenses are 
middle-aged or older. And the chief financial support 
of the red-light districts and the adventuress class 
comes from so-called respectable, middle-aged mar- 
ried men, and not from the age of youth and adven- 
ture and romance: the young have so many more 
keen interests and sources of pleasure in life. 

Even more deplorable is the other traditional as- 
sumption that it is not only natural, but necessary, 
for young men to sow their wild oats, to go through 
a period of experience and adventure in the knowl- 
edge of good and evil : in fact, that their experience 
and development are not complete without it. This 
vicious delusion did not originate with the young, 
nor is it generally believed by them until it has been 
dinned into their ears by the wisdom of their elders. 
It was invented by bald and graceless burgesses of 
the fifth and sixth ages of man, in order to put a halo 
around their youthful adventures and follies and 
render them suitable for framing in their chuckling 
memories. 

Whatever its origin, it has been responsible for 
probably as many wrecks and misfortunes and shame 
as all the hot-blooded and uncontrollable impulses of 
youth put together. It is precisely of a piece with 
that other abominable social tradition that a boy 
cannot count himself a man until he has learned to 



304 THE DOCTOR IN WAR 

drink and been at least once or twice under the in- 
fluence of liquor. The quicker both of them can be 
thrown into the limbo of exploded superstitions, the 
better, and there is where the Army has flung them. 
There is not a shred of foundation or basis in either 
science or common sense for either. That there is an 
instinct and a powerful one urging in this direction 
is perfectly true, but that instinct is for the benefit 
of the race and not of the individual, or, to put it 
more precisely, it is only when it is helpful to the 
race that it is of benefit to the individual. 

Another position which we have assumed toward 
this group of diseases is, I think, unwise, and ought 
to be modified. That is the attitude of profound dis- 
grace and moral delinquency which we have visited 
upon their unfortunate victims. It is quite true that 

-"there is an element of moral responsibility and blame 
for these diseases, because they are largely due to cir- 
cumstances and actions which are more or less com- 

' pletely under our own control, and we are justified 
in laying a reasonable emphasis on this. But, after 
all, that responsibility is only relatively greater than 
that which exists in a great many other diseases, 
which come from the violation of known laws of con- 
duct and of health. Indeed, in not a few cases it is 
no greater, on account of the dense and lamentable 
ignorance of these subjects in which our traditional 
ostrich-like education has kept the young. 



THE PLAGUES OF ARMIES 305 

At all events, the most rational as well as the most 
humane and helpful course is to waive this overdone 
attitude of disgrace and moral reproach and to regard 
the unfortunate victims of these diseases as patients 
who ought to be cured as promptly as possible and 
wards of the community who need help rather than 
scolding and denunciation. Our first duty as physi- 
cians, parents, and philanthropists is to cure them 
first and to leave the preaching till afterwards. 

Every appeal, every address to boys on this subject 
ought to make it perfectly clear that if ever, in spite 
of knowledge and good advice, their impulses should 
get the better of their judgment and they should find 
themselves in trouble, they are to come at once to 
their nearest relative, friend, or adviser and make a 
clean breast of it, and they will be neither punished 
nor scolded, least of all turned away unhelped, but 
will be simply put under the best care and in the 
way of cure at once. There is no use either crying 
or scolding over spilt milk, and there cannot be the 
slightest doubt that the vivid dread of parental or 
other wrath and denunciation furnishes one of the 
richest fields of harvest for the quack and the char- 
latan and the blackmailer. Many and many a young 
fellow who finds himself in trouble avoids and keeps 
away from the competent expert or reputable physi- 
cian whom he knows and has confidence in personally, 
particularly one who is acquainted with members of 



306 THE DOCTOR IN WAR 

his family, on account of this dread of disgrace and 
humiliation, and resorts to the advertising blood- 
suckers and blackmailers, who of course seek his con- 
fidence only for the purpose of threatening to betray 
it and exploit his dread of exposure for all that it 
is worth. If parents would make this perfectly clear 
to their sons, if guardians would assure their wards, 
if the modern type of intelligent employer would 
make it clear to the men and boys in his employ- 
ment, that if they come to him promptly and frankly 
as soon as they find themselves in trouble, he will 
regard them as sick first and sinners afterwards — 
perhaps, it would enormously help in the battle 
against these evils. And this is exactly what the 
Army medical authorities have done. 

Nor would it lower the standard of true manhood 
or moral responsibility one whit, for how many of us 
are there that are so entirely without sin that we can 
afford to cast the stone of reproach and condemna- 
tion? The boy who has been saved by prompt and 
kindly help from a lifelong menace or a lasting blood 
taint, threatening generations yet unborn, will be 
far more likely to heed the counsels of wisdom in 
future, and to exercise a helpful influence among 
those of his own age, than if he had been left to bear 
the penalty undiminished and the disgrace unaided. 
Yet to such an extreme have some of our self-styled 
moralists gone in this respect that they have actually 



THE PLAGUES OF ARMIES 307 

decried the use of salvarsan and denounced the use or 
knowledge of preventives of infection, on the ground 
that he who has sinned ought to be allowed to bear 
his punishment as decreed by an All-Wise Provi- 
dence ! 

Last and not least important comes the frank 
recognition of the prostitute, not as a "fallen sister," 
or an impulsive, romantic victim of emotionalism 
and love of pleasure, but as a poor, stupid, unfortu- 
nate feeble-wit, without the slightest conception of 
what either romance or adventure means, earning a 
pitiful and sordid living by the exploitation of her 
only gift, her sex, simply because she is too stupid 
and too incompetent to earn a living in any other 
way. 

Expert mental examinations of thousands of these 
poor creatures have shown two thirds to three fourths 
of them to be clearly and hopelessly feeble-minded, 
their average mental age being about that of a child 
of eleven. They should be regarded as wards of the 
State and protected against themselves and their 
filthy and contemptible exploiters, by education in 
beautiful school colonies in the country, until they 
are forty-five. They could be detected in advance by 
simple mental tests at from nine to twelve years 
of age, and with their segregation would disappear 
from half to two thirds of the wretched traffic of 
which they are the vehicles. 



308 THE DOCTOR IN WAR 

It is coming to be the judgment of intelligent chiefs 
of police, vice commissions, and other students of the 
problem, that the prostitute and the red-light district 
create at least two thirds of their own trade. The 
whole deplorable affair is a business, carefully organ- 
ized, advertised, touted for, run hand in glove with 
the saloons, and instinct or passion of any sort has 
astonishingly little to do with it. The only people 
who make money out of it are the men who control 
it and not the wretched women; and movements for 
its control and abolition are fought most viciously, 
not only by the brothel-keepers, but by politicians, 
pillars of the church and society, merchants and 
property-owners, who make enormous profits out 
of its supplies and huge rents out of its houses. At 
all events, boys and young men, both soldiers and 
civilians, should clearly understand that the woman 
or girl, whether professional or amateur, who offers 
them an adventure of this description, is nine times 
out of ten after their money and nothing else. 

Against dissipation and venereal disease the best 
antidotes and preventives are plenty of intelligent, 
wholesome amusements of all sorts, particularly 
athletics and dances or other forms of social enter- 
tainment, under proper auspices. It is the clear duty 
of the community to provide ample opportunities for 
this free, happy, helpful social life among its young 
people, either through the church social, the school 



THE PLAGUES OF ARMIES 309 

party, or the municipal dance or reception properly 
chaperoned, both for their health, happiness, and re- 
finement, and as an aid to the romantic and delight- 
ful, but* immensely important and serious, enterprise 
of choosing their partners for life. 

If boys and young men have plenty of good women 
and girls to associate with, they'll never miss the 
bad ones. In our American Army, both in the home 
cantonments and in France, provision is made for 
this most necessary and invaluable influence through 
the admirable Hostess Houses of the Y.W.C.A., the 
Red Cross, and other patriotic organizations. 

In this broad and intelligent spirit venereal dis- 
ease has been attacked in the armies, and the result 
has been a very triumph of common sense. From 
the earliest days of his training the recruit is thor- 
oughly and carefully instructed as to its nature and 
dangers, either by the regimental surgeons or by 
specially skilled speakers who make the round of the 
cantonments. He is put in full possession of all the 
facts, the dangers of disability and disease empha- 
sized, and then his patriotism as a soldier who must 
keep himself fit, his self-respect and his regard for 
the future of the race, are appealed to. And superbly 
has he responded. 

In spite of all the special temptations that assail 
the soldier in the camp and in the field, the rate of 
venereal diseases in the Allied armies is now less than 



3 io THE DOCTOR IN WAR 

half that believed to exist among young men of similar 
ages in civil life. The disease has been met frankly, 
not only as a moral problem, but as a sanitary one, 
taking every known and effective means of prevent- 
ing or curing as quickly as possible one of the most 
disabling diseases to which soldiers in camps are 
liable. 

That the risks of exposure to those diseases should 
not be run is accepted without question, but it is held 
that, in the language of a famous President, "it is 
a condition, and not a theory, which confronts us." 
And if once the risk has been incurred, the soldier is 
not merely instructed what to do, but provided with 
all the necessary means for avoiding an infection. 

Prophylactic stations, with hospital orderlies in 
attendance, have been established, not merely in 
every camp and camp hospital, but in our American 
Army in France in every Y.M.CA. building, so 
that the fullest opportunity is afforded to every man 
to save himself. If the soldier reports and avails him- 
self of these facilities, even if he should later develop 
an infection it is counted only as a minor misde- 
meanor; if he does not so report, his pay is docked 
during the whole time that he is under detention and 
treatment. 

What is even more effective, the men who develop 
these infections are held under constant surveillance 
in a sort of movable quarantine under military guard. 



THE PLAGUES OF ARMIES 311 

They live and eat and sleep in a special hut ; they are 
marched out under guard for special details of work, 
separate from the rest of the men ; they march back 
to their barracks in the evening and are locked up 
for the night. 

The conduct of the other troops toward this vene- 
real squad (only it is called by a shorter and much 
less polite name) is sadly lacking in brotherly consid- 
eration and Christian charity, and the fire of humor- 
ous comment to which they are subjected as they 
march about under guard is not exactly soothing. 

This method, which is carried out most perfectly 
in our American Expeditionary Forces, works so well 
in practice that at the time of my visit it had actually 
reduced the percentage of venereal disease, in a body 
of nearly 30,000 troops, to one half of one per cent ! 
And the latest report of the Special Army Commis- 
sion on Control of Venereal Disease, in May, 19 18, 
is that out of half a million men in France only one 
tenth of one per cent are under hospital treatment 
for social diseases. 

When this is contrasted with the old peace aver- 
age for the English Army, about six per cent (to say 
'nothing of the fifty-year-ago averages, which used to 
run to twelve or fifteen per cent), and that the best 
ever attained before was two per cent in the French 
Army and one and three tenths per cent in the Ger- 
' man, and that these latter figures only included the 



312 THE DOCTOR IN WAR 

men who were sufficiently disabled to be confined to 
the hospital, it will be seen that the method is not 
lacking in practical effectiveness. 

In addition, the American military police have 
the power, in the name of "la defense nationale," 
promptly to deport from the Army zone, without 
trial or other troublesome legal delays, all women 
known, or reasonably suspected, to be prostitutes, 
who have come into it since it was occupied by the 
Army. If London would tackle the problem in the 
same spirit, the disgraceful and deplorable scenes, 
which are the open scandal of the streets leading to 
most of its great railway stations by which troops 
enter the capital, would soon be wiped out. If any 
pretext save that of the defense of the realm was 
needed, it could be found by merely making a thor- 
ough mental examination of these unfortunate wo- 
men and then applying the provisions of the act 
for the protection of the feeble-minded, as from 
seventy to eighty-five per cent of them have only the 
mental development of children of eleven. 



XVIII 

THE EFFECTS OF WAR ON THE CIVIL 
POPULATION 

ONE of the most singular and sinister ironies of 
war is that its heaviest slaughter is not upon 
the battle-field. Famine at home and pestilence in 
the tented camp have ever slain from ten to twenty- 
fold as many as the clash of arms upon the open field. 
It is the men who make the wars, and the women who 
pay for them. 

In earlier wars the calling-away of all men of mili- 
tary age to the front meant, when most countries 
were from one half to two thirds agricultural in their 
population, the tilling of the land only by women, 
children, and old men, with immediate scarcity of 
food, the shutting-down of such factories as existed 
on account of the lack of raw materials as well as 
labor, which meant unemployment or low wages, all 
over the land less money to spend, and all food and 
necessaries double or treble their former price. Bread 
riots were as regular an accompaniment of former 
wars as bugles were. 

Consequently, one of our keenest interests as both 
statesmen and students of social conditions, when 
this terrific calamity broke over an unsuspecting 



3H THE DOCTOR IN WAR 

Europe, was, what would be the recoil of the war gun 
upon the stay-at-homes; how would the civil popu- 
lation stand the strains and stresses of war condi- 
tions? When I went abroad in January, 1917, after 
a state of war had existed for over two years, one of 
my deepest interests was the study of the actual 
effects of war upon national vitality, its reactions 
upon the nine tenths of the people of the Allied coun- 
tries who remained at home, rather than its more 
direct and obvious effects upon the one tenth who 
were on or near the fighting-line. For the reason, not 
merely that, forming so vast a majority of the nation, 
whatever affected them, even in less striking degree, 
was of even deeper vital importance than the fortunes 
of those in the trenches; but also that any results, 
for better or for worse, wrought among the home 
population would be likely to be permanent and to 
deeply affect the future history of the race, while 
those wrought on the battle-field, though more dra- 
matic, might be much more transient in character. 

Besides, the utmost results to be hoped from tri- 
umphant victory in the war itself were so meager, so 
pitifully inadequate to repay the blood and agony 
which they had cost: merely a return to the status 
quo, to the position in which the world fondly believed 
itself to be in the fatal summer of 19 14, when reason, 
humanity, and justice were supposed to govern the 
nations: the chaining-up of a homicidal lunatic nation, 



THE CIVIL POPULATION 315 

that we did n't even know was crazy, the safeguard- 
ing of civilization and democracy from a menace of 
barbaric world conquest that we could hardly believe 
existed. Perhaps the reflex results at home might 
show a more positive gain, a less barren triumph, some 
return even partially worth while for the wastage and 
horror of it all. 

Of course, the fortunes of the home population are 
far less dramatic and unusual and attract much less 
public attention than those of the armies. From the 
beginning the columns of the newspapers have been 
crowded with the most detailed reports of this battle 
and that skirmish, with their pitiful lists of the killed 
and the wounded, with all the news of camp, of hos- 
pital, of troop-ship, and the murderous marvels of 
howitzers, machine-guns, and bombing airplanes. But 
only a line here or a paragraph there reports the wel- 
fare or ill-fare of the nine tenths who toil patiently 
at home, growing the food, forging the guns, turn- 
ing and filling the shells, weaving the clothing and 
stitching the shoes, building the ships and manning 
the railways to supply and support the one tenth in 
the world's eye at the Front. 

But this comparative scarcity of news as to the 
conditions among the people at home was really in 
itself an encouraging sign. Prosperity and well- 
behavior seldom make good copy, and only misfor- 
tunes or misdeeds catch the eye arrestingly in the 



3i6 THE DOCTOR IN WAR 

headlines. "Happy is the nation that has no history " 
was shrewdly true in the sense that history is or was 
largely made up of records of wars and kings and 
other calamities. If there are no strikes, if there are 
no bread riots, if there are no famine-bred pestilences 
to claim prominent space in the newspapers, the hope- 
ful presumption is that the great working mass of our 
population is faring better than usual in war-time. 

Within a week of the time that one lands at Liver- 
pool or steps upon the historic soil of France, one 
becomes aware by many significant signs that this 
present war presents almost as many differences at 
home from conditions obtaining in former wars as 
have been noted in the trenches. It so happened 
that I had made various trips abroad for the purpose 
of studying different health conditions, remaining 
for two different periods of nearly two years each, so 
that I was reasonably familiar with the physical and 
hygienic conditions of the English, the French, and 
the Italian peoples; and I was instantly struck, on 
reaching the streets of Liverpool, with the fact that I 
had never seen the mass of the English people looking 
so well fed, so well dressed, and in such good general 
physical condition. 

Inquiry among my friends, both in industrial life 
and in the professions, particularly among the health 
officers, almost universally confirmed my first im- 
pressions. The death-rate, instead of being higher, 



/ 



THE CIVIL POPULATION 317 

was the lowest in years, in fact, had only once been 
surpassed. Instead of a good deal of malnutrition 
and diseases due to underfeeding among children, 
the infant mortality and child death-rate, after a 
distinct rise during the first six months of the war, 
had begun to decline and was now at the lowest level 
ever known. 

Instead of unemployment, there was an actual 
excess of jobs over applicants; wages had risen so 
that families were earning more money than they 
ever had in their lives before. And the one com- 
plaint that was uniformly voiced by my middle-class 
friends and acquaintances was that the working 
people were buying things they had never dreamed 
of possessing before, such as pianos, organs, plush 
upholstered furniture, ostrich feathers, and even 
furs and jewelry. 

More unexpected yet, vagrancy was almost un- 
known; the poor-houses were half-empty; drunken- 
ness, as indicated by the number of arrests, had fallen 
off from thirty to fifty per cent, and crime had de- 
creased in the most astonishing fashion, even in spite 
of the fact that a large proportion of the younger and 
more actiye policemen had gone to the Front and 
that the streets of all the cities were in a state of more 
than semi-darkness at night. Even though the spokes- 
men of the upper and middle classes were all firmly 
convinced that the working classes were getting far 



318 THE DOCTOR IN WAR 

higher wages than they were worth, and in the begin- 
ning of the war had loudly lamented that they would 
surely spend the greater part of the surplus on beer, 
they were now admitting that their prophecies in 
this regard had been largely unfounded, and that 
most of the munition workers were putting their high 
wages into more nourishing foods, better houses, 
more attractive clothing, war bonds, and savings 
banks. 

When I had finished my stay in England and 
crossed over to France, I found an almost parallel 
situation existing there as to the physical and finan- 
cial welfare of the great mass of the people, only in 
less degree. This was, of course, to have been ex- 
pected on all grounds, partly because France has 
much more largely a farming population, and hence 
there had been an earlier and more striking falling-off 
of and restriction in certain classes of food-supplies, 
while at the same time a much smaller portion of the 
population was benefited by the great increase in 
wages. Also because heroic France had borne the 
full brunt of the war right from the very beginning, 
while it had taken England a year and a half to put 
even an approximately large proportion of her popu- 
lation into the field. Nevertheless, the shops were all 
open and their windows crammed with goods, trade 
and traffic were good, labor was scarce, wages were 
more than doubled, the people were well dressed and 



THE CIVIL POPULATION 319 

well fed, and that most sensitive barometer of na- 
tional welfare, the children, were bright-eyed, plump- 
bodied, rosy-cheeked, and strenuous of both voice 
and limb in their happy play. 

Again, inquiry among officials, business men, phy- 
sicians, and social workers corroborated these im- 
pressions with certain exceptions. There had been 
a slight increase in the civilian death-rate, an appar- 
ent increase in tuberculosis, an increase in the infant 
and child mortality rate along, and from ten to fifteen 
miles back of the Front, on account of the indiscrim- 
inate nature of the German bombardment. But when 
all was said and done, the civil population of France 
was holding its own, not only with magnificent cour- 
age and unconscious heroism, but also with most 
gratifying and surprising physical and hygienic suc- 
cess. 

One reason for this cheering and unexpected state 
of affairs on both sides of the Channel was not far to 
seek. And that is the extraordinary degree to which 
this war is being fought by machinery. The whole of 
the Western Front in its four hundred and thirty 
miles, from the sea to the Alps, fairly bristles with 
machinery and literal engines of war of every descrip- 
tion, from the trenches clear back to the supply areas 
and the bases. Every highroad leading to the Front 
is as crowded with high-powered motors and camions 
as a railroad roundhouse is with locomotives. Our 



320 THE DOCTOR IN WAR 

fighting men march by machinery, dig with machin- 
ery, fly by machinery, and shoot by machinery; they 
do everything by machinery except eat and sleep and 
swear. So astoundingly dependent have they become 
upon mechanisms of every imaginable sort, that it is 
actually proposed to utilize chilled-steel automatic 
soldiers, mounted with rifles, whose fire can be 
directed from a safe distance, capable of rising up to 
shoot and of going down to safe cover, and requiring 
neither food, nor clothing, nor pay. 

This means an enormous and incredibly lavish 
expenditure of ammunition; more rounds can be 
fired in a minute by machinery than in an hour by 
hand as in previous wars. This is not a mere figure of 
speech ; in one single offensive on the Somme, it was 
stated in Parliament that the British Army had fired 
more shells and cartridges of all sorts than in the en- 
tire Boer War ! And every army corps of forty thou- 
sand men requires one single-track railroad running 
to its full capacity day and night, just to supply it 
with ammunition alone. 

The result has been that instead of factories shut- 
ting down and mines closing and trade stagnating 
and operatives being thrown out of employment, 
there has been an enormous stimulation of manu- 
facturing activity along a very large number of lines; 
and not merely the men who have remained at home, 
but the women and older children have been fairly 



THE CIVIL POPULATION 321 

flooded with work at wages beyond even their wildest 
dreams before the war. 

Many a soldier's family, containing one or more 
children of working age, has two to three bread- 
winners now, instead of one as before the war, and 
often each one of them earning more money per 
week than their father did, so that with the liberal 
separation allowance from the Government, they not 
infrequently have from two to three times the income 
that they had in the days of peace. The result is that 
the great majority of the working classes, including 
agricultural laborers, who form in England about 
eighty per cent of the total population, are spending 
money as they never did in their lives before. And 
while naturally some of it goes for feathers and cheap 
jewelry and taxicab rides and hothouse luxuries and 
gaudy silks and satins and screaming plush furniture, 
the bulk of it is going for richer and more varied 
meals, larger cottages in better neighborhoods, pianos 
and organs, furniture and carpets, yes, even pictures 
and china and furs and real diamonds, and, as they 
begin to sober down from their first delirium of ''gold 
fever,' ' into war bonds and savings banks and build- 
ing and loan companies. 

Even their first delirious delight of spending, what 
to them was, in classic Johnsonian phrase, "wealth 
beyond the dreams of avarice," though shocking and 
simply scandalizing to the outraged eye of the moral- 



322 THE DOCTOR IN WAR 

ists and preachers of economy of the upper and middle 
classes, had something pathetic about it. One woman 
munition worker, when her first pay-day came, 
promptly "blew in" two thirds of her earnings for a 
pair of pheasants, with hothouse grapes, mushrooms, 
and guava jelly for her wide-eyed brood. Another, 
as soon as she actually saw three whole golden sover- 
eigns lying in her palm at once, to spend just as she 
liked, without fear of remonstrance even from her 
husband, hailed the largest and most sumptuous 
public automobile that she could find and piled in 
her whole tousle-headed, shabbily dressed family for 
a ride round the parks. Another one marched into 
a fashionable department store and bought herself 
a blazing and gorgeously embroidered Japanese ki- 
mono, and insisted upon putting it on over her soiled 
and shabby working dress and wearing it home. 
Each one of them trying in one reckless, splendid mo- 
ment to gratify the ambitions, the cravings, the unful- 
filled longings of a lifetime, for something supremely 
beautiful to the eye, soft to the touch, or delicious 
to the taste. But having once blown off their accu- 
mulated steam, their long-suppressed yearnings, in 
Freudian phrase, "their strangulated emotions," 
they soon settle down to tamer and more rationally 
j balanced methods of spending. In Matthew Arnold's 
phrase "the sense in them for conduct, the sense in 
them for beauty," reached an equilibrium. 



THE CIVIL POPULATION 323 

This was most interestingly and convincingly 
shown, in the matter of foods, by actual scientific 
test and experiment. Naturally one of the first indul- 
gences which the workers gave themselves, when the 
Big Pay began to come in, was in the direction of their 
favorite savory and attractive foods, particularly 
meats, sausages, pies, and rich plummy cakes. Nu- 
merous headaches and bilious attacks and internal 
dissensions of sorts followed at first, but the net result 
was that they got more real food into their systems, 
gained in weight, improved in health and strength, 
and did more and better work than they were capable 
of before on their old poverty diets. So striking was 
this last result that the more intelligent owners and 
employers of munition plants put in well-equipped 
and attractively decorated canteens or cafeterias, in 
which they supplied a good variety of well-cooked 
and substantial foods at cost price, or in some cases 
actually a little below, so as to encourage their work- 
ers to feed themselves liberally and well. 

When the committee of distinguished scientists and 
physicians, appointed by the English Government 
to safeguard the health of workers in munition plants, 
came to study the food problem, they decided to test ' 
out the self-chosen diets of the workers of both sexes 
and various ages and see whether they were over or 
under the amount required for their condition and the 
work that they were doing, and whether they were 



324 THE DOCTOR IN WAR 

reasonably balanced. The tests were made on quite 
an extensive scale in a number of different factories, 
so as to include all classes of workers and conditions 
of work. In some of them a watch was kept upon the 
amount and kinds of food that the operatives ordered 
in the cafeterias; in others, the consent of a certain 
number of the workers was obtained to allow a 
visiting nurse to go to their homes and to take a list 
of the family food purchases for a certain number of 
days or a week. But the method which was regarded 
as freest from any possibilities of outside influence or 
abnormal conditions or embarrassment of any sort, 
was the simple but ingenious one of stationing a man 
at the men's and boys' entrance to the factory, and a 
woman inspector at the women's and girls' entrance, 
and having them offer every fifth or tenth worker, at 
random, a dollar for their dinner-pail and its con- 
tents, promising to return the pail. 

The contents of the dinner-pail were taken to one 
of the laboratories of the committee and their total 
number of calories or heat units carefully estimated, 
and the proportion or balance of the three or four 
great main food elements, proteins, carbohydrates 
(starches and sugars, fats, fruit acids, and vegetable 
alkalies) worked out. Then these were compared 
with similar findings drawn from the meals ordered 
in the canteens, and the weekly food bills in the house- 
holds. Much to every one's surprise and also grati- 



THE CIVIL POPULATION 325 

fication, the average results from hundreds of cases 
was that the diets adopted on their own initiative, 
just simply guided by their own unspoiled appetites, 
by men at heavy and at light work, by women at 
various grades of occupation, and by boys and girls, 
seldom varied more than ten or fifteen per cent from 
the ideal amount required to keep them in health at 
their age and character of work ! Which is one of the 
highest tributes to the soundness of our instincts and 
the good common sense of average humanity that 
has ever been paid. 

i There were exceptions, of course, and one of them 
the committee, with a saving sense of humor, thought 
worth while chronicling. It was a boy of seventeen, 
who was making some twenty-six or twenty-seven 
shillings a week, to his astonished eye almost the 
equivalent of as many dollars over here. His esti- 
mated number of calories required, for age, weight, 
and character of work he was doing, was thirty-two 
hundred, while the energy stored under the cover of 
that single pail represented no less than eighteen hun- 
dred calories, no trifles and knickknacks, but good, 
solid, filling slabs of cold meat and cheese and sausage 
and plum pudding and gingerbread, with a jam tart 
to finish up with, whose puff paste walls were three 
quarters of an inch thick ; which, if his other two meals 
were on anything like as sumptuous a scale, would 
bring his total intake up to the magnificent sum of 



326 THE DOCTOR IN WAR 

fifty-five hundred calories, nearly double his "text- 
book" requirements. But what are cold calculations 
like these in the happy days of youth? The delighted 
youngster was probably having all he could eat of 
what his soul most craved for the first time in his 
young life, and he was making up for years of under- 
feeding, as well as accumulating a margin for future 
growth. He was literally "blowing himself," — " do- 
ing himself extremely well," in the quaint English 
phrase, — but he would soon come down to earth 
again when he had once thoroughly caught up. And 
the committee specially noted that up to the time of 
writing his health had not suffered in the slightest, 
and he was both lengthening and thickening at a 
remarkable rate, as well as carrying his work success- 
fully. 

I talked with scores of employers, superintendents, 
and foremen, factory physicians, and welfare work- 
ers, both men and women, on my numerous visits to 
the munition works by the courtesy of the British 
Foreign Office, and they were all unanimous in de- 
claring that, with, of course, inevitable exceptions, 
the vast mass of the workers, particularly the women 
and the children, had gained weight, improved in 
nutrition and appearance, and were in markedly 
better health as a result of their experience in the 
factories. 

This seemed almost incredible, but it did not take 



THE CIVIL POPULATION 327 

long to convince me by actual personal observation 
that it was an absolute fact. The secret of it was, 
first of all, the right feeling, sound common sense, and 
patriotic devotion of the overwhelming mass of the 
workers. Incidentally, it may be remarked that one 
of the finest things that has come out of this war has 
been the tremendous respect for both the courage 
and good feeling of the common man in the trenches, 
and the good sense and public spirit of the common 
man and the common woman at home and in the 
factories, inspired in every one who has been able to 
observe either of these situations at first hand. It is 
going to form the basis of an entirely new spirit and 
relationship between employer and employee, cap- 
italist and laborer, " upper" and "lower." Every- 
where one hears the hackneyed but unreserved and 
expressive phrase, "the men — the women, are 
simply splendid." Nobody would believe before this 
trial by fire that there was so much dignity, such 
sound judgment, such inherent decency and kindli- 
ness in humanity; and the so-called "lower classes" 
cordially return the compliment to the upper. 

The second great cause why munition works, in- 
stead of breaking down the health of women and boys 
and girls, have actually built it up, rests upon the 
facts that, first of all, most of the war factories have 
been new, or so enormously expanded as to be prac- 
tically so, and so had no bad customs or traditions 



328 THE DOCTOR IN WAR 

to contend with and could be built according to the 
most modern sanitary and efficiency plans. Second, 
that they are all under Government control and. 
supervision, constantly open and subject to inspec- 
tion, living in the full light of publicity day and night. 
Last and not least, that at the instance of that great 
democratic statesman and friend of the plain people, 
Lloyd George, the Government took every possible 
step from the very beginning, both to safeguard the 
lives and health of the workers and to see that all 
controlled factories and other establishments were 
planned and conducted upon the broadest, most 
intelligent, and up-to-date industrial and hygienic 
lines. An admirable and capable committee on the 
health of munition workers was appointed in the 
first year of the war, and studied out and published 
valuable bulletins upon the various problems affect- 
ing the welfare of the war workers. The more intelli- 
gent and successful owners and employers soon dis- 
covered that careful attention to the health and 
comfort of their employees really paid and was a 
substantial factor in the earning of dividends. 

In one way the factories started under a tremen- 
dous handicap, and that was the enormous demand 
and vital necessity of a huge amount of output in the 
shortest possible time. It was a wonderful and most 
crucial test and try-out of the soundness of scientific 
and hygienic principles of production.] In the first 



THE CIVIL POPULATION 329 

weeks and months of the war, when every commander 
was shrieking for shells and rifles and cannon, all 
rules were suspended, and the workers, in response 
to the frantic urgings and appeals of both the mili- 
tary authorities and their employers, worked liter- 
ally all day and half the night, seven days out of the 
week, and gave up, as a mark of patriotic devotion, 
even their legal holidays. The result for the first few 
weeks and months was magnificent. Factories sprang 
up almost overnight like mushrooms. Utterly new 
and unskilled hands were broken in to unfamiliar 
work within a few weeks. A steady stream of arms 
and ammunition poured across the Channel. But 
v then the strain began to tell. Men began to go stale, 
to try to whip themselves up to the killing pace with 
alcohol, actually to fall asleep at their machines or 
their benches, and one after another to drop out and 
not reappear next day, and when messengers were 
sent to urge them to come back, they found that they 
had simply tumbled into bed, and slept for twenty- 
four, thirty-six, forty-eight hours at a stretch. What 
was worse, the quality of production was falling off. 
"Duds" were becoming more frequent among the 
shells instead of less so. The men and women workers 
were getting quarrelsome among themselves and 
difficult to deal with by their superintendents. 

Here was the health committee's chance. They 
came forward with what at first sight was fairly 



330 THE DOCTOR IN WAR 

scoffed at as a hopelessly heroic remedy, namely, 
cutting down the hours of work to nine or less a day, 
restoring the Saturday half-holiday, abolishing Sun- 
day work, and discouraging overtime work as much 
as possible. The cure looked simply suicidal to most 
employers, but the situation was desperate, and a 
few of them were intelligent or reckless enough to 
give it a trial. To their intense astonishment it 
worked, just as we doctors had been telling them it 
would for nearly twenty years past. Men and women 
who were working twelve, thirteen, and fourteen 
hours a day, either on piece-work or on output which 
could be easily counted and estimated, such as shell 
fuses, for instance, on being cut down to eight and 
nine hours a day, not only did not lose ground on 
their output, but actually increased it. 

So that England 's population is doing its war- 
work under almost ideal hygienic conditions and 
hours, and fairly thriving on it, as evidenced by the 
significant fact that both the death-rate and disease- 
rate of the entire civilian population, as well as the 
infant-mortality, have during this war reached the 
lowest levels on record in history, and the total 
population of England is slightly but distinctly in- 
creasing year by year, in spite of her terrific losses 
in the field! 



XIX 

GUARDING THE HEALTH OF THE NAVY 



M 



AN is by nature an amphibious animal. The 
famous old sentimental ballad, — 

"Sigh no more, ladies, sigh no more, 
Men were deceivers ever, 
One foot in sea and one on shore, 
To one thing constant never," — 

however painfully uncomplimentary it might be in 
its first and last lines, is absolutely and historically 
truthful in its third. In fact, his inconstancy might 
be stated in even stronger terms nowadays, not 
merely double-faced, but triple-faced, as judging by 
the success of his recent invasion of still another ele- 
ment, the air, he is likely soon to find himself equally 
at home in all three. 

At present and by comparatively ancient tradi- 
tion, we have come to regard ourselves as land ani- 
mals, and having conquered a partial and precarious 
footing upon the cruel and treacherous sea only at 
great venture and peril. But as a matter of historic 
and geologic fact, we were originally hatched just 
about where the old ballad describes us as still stand- 
ing, where sea and land meet, and we followed the 
sea for thousands of aeons before we finally turned 



332 THE DOCTOR IN WAR 

our swim bladders into lungs and our fins into feet 
and clambered up on to the mud-flats for keeps. Then 
mark how history repeats itself. No sooner did we, 
in the dawn of that day before yesterday which we 
call historic times, succeed in conquering the waves 
and breaking through the encircling barrier of "the 
white and wailing fringe of sea," by the achievement 
of what Ruskin describes as man's greatest and most 
momentous single invention, the ship, a little section 
of dry land, which would carry its shell-full of pre- 
cious air skimming across the surface of the deep, 
than we began to live upon the sea again and to build 
our towns and our marts, our fortresses and our 
palaces, our great cities and the capitals of our world 
empires, upon its salty marge, where their feet could 
be washed by its ebbing and flowing tides. 

One curious illusion, however, still clings to us as 
the result of our long, long dry spell between the 
salamander stage and the ship, and that is, that life 
upon the sea is dangerous and uncertain to the high- 
est degree as contrasted with the peaceful safety of 
life on shore. All our litanies are full of prayers "for 
those in peril on the sea." Most of the adjectives 
which are applied to "the great world mother, 
mother and lover of men, the sea," are harsh and 
unkindly ones, "cruel," "hungry," "treacherous," 
"merciless," "angry," "devouring," "engulfing." 
Kipling's Norseman's wife cries out to her husband — 



THE HEALTH OF THE NAVY 333 

" What is a woman that you should forsake her 
To go with the old, gray widow-maker?" 

And his splendid trumpet song of "England's Dead" 

begins — 

"We have fed our sea for a thousand years, 
But she calls to us, still unfed; 
Though there's never a wave of all her waves 
But marks our English dead." 

As a matter of cold statistical fact, fewer lives are 
lost at sea by hurricane, by shipwreck, by fire, by 
hidden reef or uncharted rock, by all the perils of the 
deep, than are swept away by any one of a dozen of 
our minor diseases and pestilences. The sailor ranks 
high in the tables of longevity, only a little way below 
the farmer and the clergyman; he is in far more 
danger from fire-water than he is from sea- water, and 
is an excellent life risk if he only keeps away from the 
former. On the face of the figures, following the sea 
is one of the safest and healthiest of occupations, 
while the actual mortality of all those who go down 
to the sea in ships, whether as passengers or seamen, 
is far lower than that of those who remain on shore. 

In fact, the attitude of the ancient sailor-man 
chantey — 

"The wind it blew a hurricane, 

The sea was mountains rolling, 

When Billy Buntline turned his quid 

And said to Billy Bowling, 
'Old Boreas is a-comin' Bill; 

Don't you hear him roar now? 

And don't you pity all poor folks, 

That are upon the shore now? ' " 



334 THE DOCTOR IN WAR 

is far more rational and in accord with the facts of 
the case than the traditional sentimental melancholy 
of the "men must work and women must weep" 
order. 

Of course, there are certain cold-blooded deduc- 
tions which must be made from these apparent re- 
sults, such as that sailors consist exclusively of men, 
the great majority of whom are in the prime of life, 
and of a considerably higher degree of toughness and 
resisting power than the average, otherwise they 
would have been weeded out and discouraged by the 
hardships which they have to meet. And as regards 
the floating population having a lower death-rate 
than the shore one, the suggestion of the well-known 
paradox about bed being the most dangerous place 
in the world because so many people die there, must 
also be borne in mind. But when all the deductions 
have been made, the single fact still remains, that 
we are actually safer afloat than ashore, and the risks 
and dangers of this present war are a striking illus- 
tration of the general rule. 

On the face of the figures the navy of any of the 
first-class powers is one of the healthiest places in the 
world, a regular floating health resort. The death- 
rate in the British Navy, for instance, from all causes 
for the ten years before the war had averaged less 
than four per thousand per year, and in 19 13 had 
actually fallen to 3.24 per thousand, a good average 



THE HEALTH OF THE NAVY 335 

death-rate on shore being from fourteen to sixteen 
per thousand, while our own navy is only a fraction 
of a per cent behind this. Of course, it must be re- 
membered that the Navy is manned entirely by boys 
and men of from fifteen to forty-five, the vast ma- 
jority being under thirty, in the very prime of life, 
the literal Golden Age of health; that they are se- 
lected after a careful physical examination and given 
a thorough try-out during the first six months of 
their service, to weed out and reject any who are not 
up to the standard, or cannot be built up to it. 

But even allowing for all this, their death-rate and 
disease-rate afloat is only about half that of men and 
boys of the same ages on shore. And as the personnel 
of the Navy represents a thoroughly average sample 
of the total community ashore, if anything a some- 
what larger proportion of its force being drawn from 
the more poorly paid working classes than would be 
found in an average town or county, it is fair to con- 
clude that at least three fourths of the boys of all 
classes on shore could be brought up to the same 
standards of health if they were caught young and 
given the same treatment. 

Indeed, the Navy is a standing and shining exam-- 
ple of what could be done to improve our national 
health and vigor by giving intelligent attention to the 
matter. Its splendid results are the more remarkable 
because they have been achieved under quite unfa- 



336 THE DOCTOR IN WAR 

vorable circumstances, in many respects, and in a 
very narrow and limited environment. A warship, 
even of the hugest, is an extremely cramped and lim- 
ited sort of a place between decks. Its star or parlor 
boarders are, of course, the engines and their coal. 
Its second-floor front tenants are the guns and their 
ammunition, while the men are third-floor back and 
hall-bedroom boarders, and have to tuck their mess- 
rooms and sleeping-spaces into whatever corners and 
gaps are left. 

This means that the problems both of ventilating 
and lighting the sleeping-places of a battleship's 
company have always been difficult ones. In fact, 
only in the more modern ships since the introduc- 
tion of electric lighting and of special fan systems of 
forced ventilation, have these problems been at all 
adequately solved. Further than this, the difficulty 
of obtaining regular supplies of perishable food, such 
as fresh vegetables, fresh meat, and fresh fish, has 
always been great, until, in the more recent ships, it 
has been overcome by the introduction of ice or of 
refrigerating plants. 

Then, too, voyages were long and monotonous, 
there was nothing approaching society on board, and 
very little in the way of entertainment or intelligent 
amusement. The men got stale and restless, and when 
finally they were given shore leave they were disposed 
to try and make up for lost time and "take in" the" 



THE HEALTH OF THE NAVY 337 

whole town and its excitements inside of forty-eight 
hours, with the result that they frequently came back 
with " a head like a concertina," a beautifully pickled 
stomach, and a prospect of venereal disease. 

It is most interesting to watch how, as these special 
difficulties have been faced and conquered one after 
another, the death-rate of the Navy has steadily gone 
down year after year from about fifteen per thousand, 
fifty years ago, to eight, thirty years since, and finally 
down to the present three. There has been no magic 
about the process, simply good, common-sense, hygi- 
enic methods. First of all, improving the food and 
making it not merely sound and nutritious, but inter- 
esting and attractive to the men, especially by means 
of fresh vegetables, fruits, andjsugars. This not only 
greatly improved the health and comfort of the men 
and kept them better satisfied with the monotony of 
their life afloat, but it also greatly diminished their 
tendency to accumulate "a thirst" or craving for 
one tremendous drunk and spree whenever they 
reached the first port and got shore leave. 

Then the electric light, in place of two or three 
smoky oil lamps, which could do little more than 
emphasize the darkness all round the walls, by throw- 
ing a flood of illumination into every corner of the 
mess-rooms has made it possible for the seamen to 
read and write and sketch or carve or play games 
with ease and comfort, thus greatly diminishing the 



34° THE DOCTOR IN WAR 

fighting decks, to take to their boats and even to 
carry off a considerable proportion of the wounded. 
But the modern armor-plated and high-engined 
battleship, which is a marvelous instrument of 
destruction and a literal floating fortress, — as long 
as she floats, — when she does make up her mind to 
go down, founders with appalling suddenness. One 
single fifteen-inch shell may sink her almost as sud- 
denly as a rifle bullet would a floating bottle. And as 
her entire ship's company is under cover, many of 
them in the engine-room and at the munition hoists 
or in the sick-bay, three or four stories under water, 
their chances for escape are pitifully small. 

Kipling has voiced the deep-seated reluctance of 
the old-fashioned sailor-man against "going to sea 
in the works of an eight-day clock," and in one sense 
the old salt's objection is thoroughly justified. On 
my visit to the English Fleet, for instance, I met a 
young captain, a handsome, clear-eyed, almost boy- 
ish-looking young officer, who was the sole survivor of 
an entire skip's crew and company of thirteen hundred 
men. It was in the Battle of Jutland, and he had 
pluckily climbed up under a hail of fire into the high- 
est fighting top, with his glasses, in order to get a 
clearer view of the enemy's ships through the North 
Sea smother and spray. A single half- ton shell struck 
her at the water line and exploded in her engine-room, 
and she went down within a hundred seconds. As 



\ 



THE HEALTH OF THE NAVY 341 

she went down, she heeled over suddenly to port, 
and he was flung out of the fighting top as from a 
catapult, and landed in the sea a hundred and fifty 
feet away from her side and clear of her vortex. By 
great good luck he was unhurt by the fall, and when 
he came up to the surface found himself within a 
hundred yards of a destroyer, swam to her side, and 
was taken on board. And as the Germans were fol- 
lowing their usual tactics of firing upon the wounded 
in the water and upon any boats that put out to their 
rescue, he was the only one who lived to tell the tale. 

An additional horror has been added to this grim 
risk of modern naval battle by the fact that the Ger- 
mans have burned up all the moral codes and funda- 
mental decencies, and not only fire upon all boats 
put out to rescue the wounded, but send up their 
submarines to torpedo the ship which checks her 
headway for this purpose. Two thirds of the first 
English and French vessels which the Huns succeeded 
in sinking were caught in this dastardly way, and the 
Admiralty was compelled to issue an order forbidding 
the lowering of boats for the rescue of the wounded, 
on account of the serious risk to the much larger 
numbers on board the ship. 

In some instances the Huns actually fired upon the 
English boats which were putting out to rescue Ger- 
man wounded struggling in the water. If they could 
get two English lives by the sacrifice of one of their 



342 THE DOCTOR IN WAR 

own, the transaction showed a clear profit, in their 
code of morals. 

Another somewhat unexpected result of the tre- 
mendous piercing and explosive power of the big 
shells, combined with this new sea-wolf code, has 
been the complete reversal of the usual proportions 
which obtain between killed and wounded in land 
battles. The one ratio in the present war which has 
not changed is that between killed and wounded, 
which has remained curiously constant at between 
four and five to one for the last two hundred years; 
that is to say, out of every hundred casualties twenty 
will be deaths, twenty rather serious wounds, and 
the remainder, light wounds. In a few battles in the 
earlier months of the war, before methods of protec- 
tion against modern artillery had been properly de- 
veloped, the proportion of killed outright ran some- 
what higher, in some instances up to thirty and even 
fifty per cent of the total casualties, but of late the 
tendency has been strongly in the other direction, 
and in the engagements of the past summer, in the 
British Army, for instance, the proportion fell as low 
as only one death in six and even one in ten casualties. 

The situation in the Navy is almost exactly the 
reverse of this, and in its only two or three really 
important engagements of the war, while, of course, 
it is not permitted to publish the exact figures, the 
number of wounded was barely one tenth that of the 



THE HEALTH OF THE NAVY 343 

dead. A " JackyV risk, therefore, is almost literally 
"neck or nothing." He either escapes scot-free or 
goes to the bottom, nine times out of ten. 

This grimly simplifies the problem of caring for the 
wounded and makes hospital ships far less necessary 
than was anticipated, as each battleship that remains 
afloat after an action is pretty nearly able to take 
care of her own wounded until she can carry them 
into port herself, or transfer them to a light armored 
cruiser, which will act as collecting ambulance for 
the entire fleet. 

Each battleship has a well-appointed and equipped 
sick-bay or small hospital ward, with from ten to 
fifty beds, according to her rating and the size of 
her company. There is an operating-room, an X-ray 
equipment, steam sterilizers, and everything which 
is needed to take care of all but the most complicated 
cases of surgery. Everything is spotlessly clean, and 
there is a highly competent staff of surgeons and 
assistants and hospital attendants on board each of 
the larger ships, but the quarters are necessarily 
cramped and fearfully noisy for men whose pain 
keeps them awake. 

Moreover, even the biggest dreadnoughts and 
cruisers, though they ride the waves nobly, are not 
exactly transatlantic ferries, especially in rough 
weather, while the destroyers are just about as easy 
to ride as bucking broncos and little better than 



344 THE DOCTOR IN WAR 

jumping hells for men with deep wounds or broken 
bones. Their hearts are literally too big for their 
bodies, and the whizzing speed at which they are 
driven by their tremendously powerful engines gives 
them no time to ride over the waves, but sends them 
slap through them, like flying thunderbolts, or even 
scooting from one wave crest to another like a skip- 
ping stone playing ducks and drakes. It is a never- 
ending marvel how they manage to keep afloat at all 
in rough weather; they come heaving up out of the 
sea smother like a huge flying dragon swattering 
along the surface of the water; by the time you have 
made out what they are, they are abreast of or on 
top of you, and you duck to let them go over your 
head, and before you can catch your breath and turn 
round, they are hull down and out of sight on the 
horizon behind you, leaving nothing but a trail of 
smudgy smoke and a whining roar like a big shell, to 
prove that they have ever been there ! They are like 
flying expresses tearing along the surface of the sea, 
and you would n't be surprised at any moment to see 
them rise right up into the air like a big airplane — 
all that seems necessary would be a feather duster 
on each side of them. In rough weather their crews 
have to be strapped into their bunks at night to keep 
from being hurled out on to the floor, and for wounded 
men they are simply impossible. 

The proposed plan and normal method of handling 



THE HEALTH OF THE NAVY 345 

the wounded in the Navy was for each fleet to be 
accompanied by its hospital ship or ships following 
at a safe distance behind it and steaming rapidly up 
after an action to take on board the wounded from 
the different ships. But this plan has been seriously 
interfered with by the new conditions. First, because 
the hospital ships are not fast enough to keep up with 

the battle fleet, which has to steam like in order 

to try and catch up with the Germans before they 
can get back to port. Second, because, in order to 
transfer wounded, a battleship is obliged to heave to, 
and this exposes her to torpedo attacks by subma- 
rines. Third, the transfer of wounded from huge float- 
ing fortresses like modern battleships is only possible 
in the calmest of weather, and this practically never 
happens in the North Sea. It furnishes a wide variety 
of weathers, but each is usually rather worse than 
the one before it. Whenever it does n't blow, there is 
fog, and whenever there is n't fog, it is blowing at 
least half a gale. 

In order to meet this situation, it has been sug- 
gested that small, swift vessels of about five or six 
hundred tons, registered and protected according to 
the Geneva Convention, should be specially equipped 
to pick up rapidly survivors from the sea or to hang 
alongside moving battleships _and catch the wounded 
as they are slung overboard. 

But even these would still be subject to the last 



346 THE DOCTOR IN WAR 

and greatest difficulty of all, and that is, the habit of 
the Hun submarine sea-snakes, of torpedoing and 
sinking every hospital ship that they can reach on 
one lying pretext or another. 

But in actual practice so far no serious difficulty 
has arisen, party because the German warships, most 
judiciously, have kept so close in the shelter of their 
own ports, where most of them are reported to be 
roofed over with a sort of floating boat-hClise, which 
keeps out drafts and the damp air and prevents de- 
terioration of their equipment and crew. Partly be- 
cause they make such excellent time back to their 
kennels whenever they do prowl cautiously out and 
happen to run into something, that there has been 
little difficulty in every battleship which has been 
lucky enough to catch sight of a German getting 
back to where it is safe to transfer the wounded to a 
hospital ship, or even to land them at one of the 
home ports. 

These hospital ships are beautifully equipped with 
every modern medical and surgical appliance, with a 
full surgical staff and splendid corps of women nurses 
supplied by Queen Alexandra's Royal Naval Nursing 
Service. They are literally floating hospitals in the 
best sense of the term, with cots for from two hun- 
dred to three hundred cases, divided into wards on 
the different decks, and with perfect lighting and 
ventilation everywhere. The wounded I saw on the 



THE HEALTH OF THE NAVY 347 

two which I visited were literally in clover and as 
comfortable and well cared for as if in a modern city 
hospital on shore. But as the Navy surgeons who 
accompanied me pointed out, for the reasons already 
mentioned the hospital ships were practically com- 
pelled to remain at anchor most of the time, and it 
was only a matter of a few miles farther steam- 
ing to discharge the wounded men at the landing- 
stage, where the ambulances were waiting to carry 
them up to the hospitals on shore. And as the sum 
paid for the charter of these commodious and beau- 
tiful hospital ships was in the neighborhood of a 
thousand dollars a day, a good hospital completely 
equipped, convenient to the landing-stage, with the 
same capacity as the ship, could be built for about the 
cost of six months of her charter. So that it looks as 
if in future wars the naval hospital ship will probably 
be replaced by much smaller, swift vessels acting as 
marine ambulances and picking up the wounded, 
either from the water or from the battleships, and 
making a flying trip back with them to the nearest 
port where there is a hospital train or a port hospital. 
" Another somewhat unexpected thing about the 
wounded in the sea-fighting of this war was, that 
although the shell splinters with which they were 
struck had had no opportunity to bury themselves in 
the ground before exploding and so come up loaded 
with all the germs and filth of manure and fertilizer, 



348 THE DOCTOR IN WAR 

nevertheless, almost every one of them was infected, 
although, of course, not nearly so heavily and viru- 
lently as those of the land battles. 

Part of this might be accounted for by the fact that 
some of the wounds were made by splinters from the 
deck or sides or furniture and equipment of the 
ships themselves, which, of course, even with the most 
perpetual scrubbing and spotless cleanliness, could 
hardly be kept aseptic, what with grease and grime, 
coal dust, and human traffic. But it also supports 
the impression, which is quite general among Army 
surgeons, that the fragments and filling of modern 
explosive projectiles are by no means aseptic, even 
when they burst in the air and have no opportunity 
to touch the ground at all before exploding. 

I made careful inquiries at a number of the big 
munition works which I visited, as to the nature and 
handling of the "filler" which is put into the shrapnel 
shells to pack the bullets into a solid mass, and found 
that it was composed largely of a gelatine-like sub- 
stance, which was liquefied by heating and then 
poured in to fill up the little spaces between the bul- 
lets, much as syrup is poured into a jar of raspberries 
or strawberries in canning. And as gelatine is made 
out of the hoofs and bones of horses and cattle, with- 
out any attempt to render these sterile, except for the 
finer grades which are to be used for food purposes, 
and as the heat applied in melting was not at all suffi- 



THE HEALTH OF THE NAVY 349 

cient to destroy any germs which it might contain, 
it is possible that this might have been our source of 
the practically universal infection of all war wounds 
from explosive projectiles. Some of the larger shells 
were filled up with irregular cubical fragments of 
scrap iron shoveled right up from the earthen floor 
of the furnaces and foundries, and this, of course, 
might easily mean another source of infection. 

Several of the military eye surgeons, both Navy 
and Army, expressed their surprise that so many 
wounds of the eyes with which they had to deal were 
infected and suppurated, in spite of everything that 
could be done. And this, too, in a number of cases 
where the eyes had been wounded by fragments of 
shrapnel which were known to have burst in the air. 

The most singular splinter driven into an eye by 
the explosion of a shell was one reported to me by 
one of my Navy surgeon friends in the Home Fleet. 
The eye was so hopelessly torn and lacerated that it 
had to be removed, and on cutting it open to find the 
splinter which had destroyed it, my friend was as- 
tonished to discover, deeply embedded in the eye- 
ball, Si fragment of bone from a human skull. It was 
nearly three quarters of an inch square, large enough 
to be perfectly recognizable as a portion of the vault 
of the skull, and on inquiry it was found that the 
wounded man's mate at the gun had had his head 
blown to pieces by the same shell! 



350 THE DOCTOR IN WAR 

Even for all the difficulties which Hun brutality 
has created in the way of caring for the wounded, the 
same splendid results were obtained as in the Casu- 
alty Clearing-Stations and Base Hospitals on dry 
land ; that is to say, a recovery rate of between ninety 
and ninety-five per cent and a hospital sojourn of an 
average of less than three weeks before the wounded 
were discharged as recovered, eighty per cent of them 
to return to active service. 

Nothing could be more thorough and admirable 
than the system which has been planned and installed 
for the care of the wounded from the fleet when they 
are once landed. Hospitals were built both in the 
towns nearest to the several rendezvous of the great 
fleets, and beds were provided in almost every town 
of any size on or near the eastern coast of England, 
this being the only one which German warships other 
than submarines had any possible chance of reaching. 
Then ambulance units were organized in or near 
practically every tiniest harbor or even fishing village 
which possessed a landing-stage or pier and where 
there was a possibility of wounded men being landed 
after an action. These were connected by telephone 
and motor with the nearest city hospital, so that any 
ship's launch, with a cargo of wounded, could strike 
the English coast at any point at random and upon 
wireless or rocket signal find an ambulance and crew 
at the pier or beach to meet them and transport 



THE HEALTH OF THE NAVY 351 

them to a hospital bed within thirty or forty minutes 
at the outside. 

Then, to link this long line of ambulances and 
hospital stations, four hospital trains were con- 
structed, which made regular backward and forward 
trips on an average every three days from the north- 
ernmost group of hospitals and landing-stages right 
down to the great Base Naval Hospitals in the South, 
such as those at Chatham, Portsmouth, Plymouth, 
etc. I had the pleasure of making the trip with a 
company of sick and wounded on one of these am- 
bulance trains from the far North right down to 
the southwestern coast of England. The train was 
made up of twelve coaches and had cots for a hun- 
dred and twenty and sitting space for fifty lightly 
wounded. They had a staff of two surgeons, thirty- 
six stewards and sick berth attendants, and were 
arranged corridor fashion, so that the surgeons and 
attendants could readily pass from one end of the 
train to another at any moment. They had, of course, 
a kitchen and full cook staff and served excellent 
meals en route, and had a well-equipped dressing- 
room, dispensary, and even a small operating-room, 
where emergency cases could be dealt with. Stops 
were made at each of the principal towns, where sick 
or wounded who had recovered sufficiently to travel 
and wanted to go south were taken on, or where 
wounded men from the northern bases were dis- 



352 THE DOCTOR IN WAR 

charged because their families lived in that neighbor- 
hood, and so would be able to visit them during their 
convalescence in the local hospital. It would have 
been hard to imagine anything more efficient and 
more comfortable, and it left in one's mind a feeling 
of absolute certainty that the surgeons of the British 
Navy would be able to deal promptly and effectively 
with even the largest possible rush of wounded from 
the greatest of naval engagements in record time and 
magnificent style. 

As for the general health of the Navy, both the 
British and our own can show the same splendid 
record that our armies can, namely, an actual reduc- 
tion of its already low level in time of peace, and far 
below that of the civilian population of the same ages 
on shore. The only diseases which have caused any 
trouble in this war have been measles, diphtheria, 
and cerebro-spinal meningitis among the recruits and 
boys from the Naval Reserve chiefly in the training 
schools on shore, just as occurred with the Army re- 
cruits in their training-camps. The same curious in- 
creased susceptibility to the milder diseases of child- 
hood, such as measles and scarlet fever, as was shown 
in the Army by the Australians, the New Zealanders, 
and the recruits from Shetland and the Orkney 
Islands, has also shown itself in the Navy among the 
boys from the same Northern islands. Some of the 
surgeons were sufficiently interested to trace back the 



THE HEALTH OF THE NAVY 353 

cases and communicate with the local physicians in 
the Northern islands, and found that in most of them 
measles, for instance, would only occur once in six or 
seven years, when infection happened to be brought 
in by children from the mainland. So that many of 
the Shetland and Orkney boys and girls grew up with- 
out ever having been exposed to the infection, and 
the community as a whole had developed no distinct 
resistance to the disease. 

There has also been some slight increase in the 
other common infections, due to the fact that a flood 
of new recruits has poured into the Navy raising its 
war strength to nearly three times the numbers of 
its peace footing. But the new recruits have for the 
most part been vigorous, sturdy men and boys, a 
large number of them fishermen or coastwise sailors 
and merchantmen, who were brought into the mine- 
sweeping and patrolling divisions, and the excellent 
food and care which they have received has quickly 
brought them up into first-class condition, as soon 
as they have "sweated out" the few scattering infec- 
tions which they brought with them from shore, so 
that the total sickness-rate of the whole force has 
not been appreciably increased. 

Rather unexpectedly, in view of the striking purity 
and healthfulness of sea air and the fact that sea 
voyages have long been recommended for the cure of 
pulmonary disease, there has been a slightly larger 



354 THE DOCTOR IN WAR 

number of invalidings for tuberculosis than might 
have been desired. But this is barely half the rate of 
this disease among men of the same ages on shore, 
and is due to the inevitable and perplexing problem 
of providing adequate ventilation and sufficiently 
frequent change of air for a thousand men, where 
there is theoretical or ideal cubic space for only three 
hundred. And with the infinite pains and skill taken 
in equipping the newer ships with elaborate systems 
of forced ventilation by means of fans, even this age- 
old problem is well on the way toward solution. The 
introduction of oil-burning engines and of turbines is 
also helping to solve the problem, because this makes 
nearly two thirds of the space taken by coal bunkers 
and engine-rooms available for sleeping-quarters and 
mess-rooms and reading-rooms for the men. 

The largest number of cases under one heading 
falls naturally to the credit of that special pest of 
the soldier and the sailor, venereal disease. But this, 
so far from increasing during the war, has shown a 
marked and gratifying diminution, due to the new 
and intelligent methods of dealing with it. In fact 
it was the Navy that was the first to set the example, 
which has been followed by the Army with admirable 
results. Frank and friendly talks were given to the 
seamen by the Fleet surgeons, covering every aspect 
of the subject, the dangerous after-effects of the 
disease and its menace to their future wives and 



THE HEALTH OF THE NAVY 355 

children. Then they were given protective remedies 
against it, and were told that if, on their return to 
the ship, they promptly reported to the hospital 
orderlies if they had been exposed to infection, they 
would be put under treatment at once and neither 
punished nor docked of their pay even if the infection 
should develop. 

Theoretically, this method is open to the single 
objection that it teaches the men how they may run 
risks with comparative impunity. But, practically, 
this possible lessening of the fear of infection has been 
heavily overbalanced by the increase of the men's 
intelligence and knowledge of the disease and the 
appeal to their patriotism and their respect for their 
wives and future children. In the paradoxical lan- 
guage of a famous cynic, "Nothing survives being 
thought of," not even the running of venereal risks. 
At all events, the figures have fallen to barely half 
of the peace-time prevalence of the diseases, that is 
to say, about five in a thousand. What this means 
may be gathered from the instance of one large battle- 
ship, which on touching at a certain port gave eleven 
hundred of its men shore leave, with the result that 
only three cases of venereal disease followed ! 

By a curious paradox the next prominent disease in 
the Navy in time of war is neurasthenia and mental 
depression. What a set of bluff and jolly "Jack 
Tars," in their home on the ocean wave in piping 



356 THE DOCTOR IN WAR 

times of war, should be doing with a parlor disease 
like this is at first sight a puzzle. But it is explained 
by the fact that after the first few months, when 
there were still a few German war vessels and cruisers 
afloat to provide a moderate amount of excitement, 
the task of the Navy has been one of constant 
and sleepless strain and watchfulness in all sorts of 
weathers — except good — with the most tremen- 
dous interests and responsibilities hanging upon any 
slackening of vigilance, and with nothing whatever 
happening to break the monotony. They have 
cruised backward and forward, backward and for- 
ward, in fog and rain and spindrift, and snow and 
storm and sleet, day after day, month after month, 
for four mortal years, and except for the Battle of 
Jutland, the clash off Heligoland, and an occasional 
brush between destroyer patrols, with nothing what- 
ever to show for it. This is admirable prudence on 
the part of the enemy, but bitterly disappointing to 
our sailor-boys. To sweep the sea for four long years 
with the finest fleets ever assembled under one group 
of flags and be unable to get a fight out of anybody 
is enough to drive any set of sailors to mental depres- 
sion or to drink. 

Of course, they know, and the world well knows, 
that they have swept the seas of the world clear of 
every craft that dares fly the enemy's flag above the 
surface, that they have drawn a noose around the 



THE HEALTH OF THE NAVY 357 

neck of the German Brute and are slowly but surely 
strangling him to death, that but for their superb, 
devoted and almost thankless service the war would 
have been ended in six months, that they have 
transported and convoyed across the seas millions of 
troops, their equipment and four years' supplies, with 
the loss of less than a thousand soldiers, and have kept 
all the highways of the seas the world over safe for 
the commerce of civilization and freedom. But this is 
poor personal consolation to half a million fighting 
Jack Tars, all of them just praying for a " scrap," 
and it is little wonder that they get melancholy and 
despondent in their minds about it. The only nerve 
tonic that would cure their depression is for the Ger- 
man polecat to come out of his hole and give them a 
chance to even up scores and express their opinion of 
him in the only language he can understand. 



XX 

SHELL-SHOCK AND THE MENTAL STRAIN 
OF WAR 

THE first thing that was predicted of this war 
was that human nerves, especially civilized 
nerves, could never stand the strain. That our sensi- 
tive neurasthenic nervous system, keyed up and pam- 
pered by the abnormal conditions of city life, would 
break down under the shock of its horrors. Not only 
would our soldiers become nervous wrecks, but the 
ruin of their mental balance would be so utter and 
foundation-shaking that generations yet unborn 
would pay the penalty in an inheritance of terror 
and morbid fear! Forgetting, as any biologist could 
have told us, that the nervous system is by a strange 
paradox, both the most sensitive and the toughest 
part of the animal ! Here the war has been going full 
boiler-shop hammer and tongs for three years, and 
our insane asylums, instead of being crammed to 
overflowing with the mental wrecks of the war, are 
actually getting emptier every year, and the thou- 
sands of babies born of war marriages are as fat and 
sturdy and crowing and normal in every way as ever 
clutched at sunbeams or tried to get their pink toes 
into their mouths. 



SHELL-SHOCK 359 

What has been the net result of three years of con- 
tinuous war upon the nerves of the soldiers? Aston- 
ishingly little, on the whole. Indeed, far the heaviest 
nerve-strain of this war has fallen upon the anxiously 
waiting or bitterly weeping wives and mothers and 
sisters at home. Yet column after column and head- 
line upon headline have been devoted to " shell- 
shock." 

As soon as you come to look into the facts of the 
situation you find, first, that the term " shell-shock* ' 
has been and is yet extremely loosely used, and sec- 
ond, that it has attracted ten times the attention 
that its importance really deserves. 

"Shell-shock," in fact, has been applied as a con- 
venient term for any form of disability in a soldier not 
accompanied by a visible wound, or other clear physi- 
cal injury. It has been a diagnostic dump on which 
have been shot all sorts of disturbances which had 
no clear and obvious cause, and has proved as blessed 
a convenience for pathologic haziness as "neuras- 
thenia," "uric acid," or "general debility." It satis- 
fies both doctor and patient and means nothing in 
particular. 

As soon as the litter is emptied out of the shell- 
shock waste-paper basket and attempt is made to 
sort it, most of it falls roughly into two quite distinct 
and different groups. 

One, in which the patient, or his comrades, give a 



360 THE DOCTOR IN WAR 

clear history of his having been knocked down, or 
hurled some distance, or blown up into the air, or not 
infrequently buried by the blast of a high-explosive 
shell. He is picked up unconscious and awakens in a 
dazed, half-delirious state. Or else he is found wan- 
dering about in a sort of walking delirium, quite out 
of his head, having forgotten, not only what caused 
his condition, but also the number of his regiment, its 
bivouac, and even his name. 

After a few days' rest and care, his delirium sub- 
sides, his memory comes back, he complains of in- 
tense fatigue, weakness, and general muscular sore- 
ness, due probably to the physical shock and violence 
inflicted by explosion; but this steadily improves, 
and unless internal damage has been done most of 
this class of cases get well. 

A few, however, unfortunately, remain perma- 
nently weakened both physically and mentally, al- 
though their minds clear and memory comes back, 
and still fewer break down rapidly and ultimately die. 
Post-mortems held upon some of these show innum- 
erable small hemorrhages scattered all through the 
substance of the brain, due to the rupture of tiny 
blood-vessels by the terrific shock, even though the 
skull itself was not fractured. This greatly helps to 
explain the symptoms of this class of cases, for prob- 
ably many who remain permanently weakened both 
muscularly and nervously have had their brain sub- 



SHELL-SHOCK 361 

stance actually damaged in this way, though not 
severely enough to cause either paralysis or death. 

Shell-shocks of the second group, though at first 
sight somewhat similar, are really quite different in 
character. They resemble those of the first group in 
that they usually occur after a battle and the patient 
is found wandering about in a dazed or demented 
condition. 

But here the likeness ends, for when the victim 
rambles or is brought into a Field Hospital, he often 
gives a most dramatic and harrowing story of having 
been hurled yards up into the air by a tremendous 
explosion, or buried for hours in a dug-out or shell- 
crater, or seeing his comrades blown to pieces before 
his eyes, and perhaps spattered with their blood and 
brains! Quite different from the halting speech and 
hazy memories of the real shell-shocks. On investiga- 
tion his moving story is usually found to be only 
partially true, and often totally unfounded — a pure 
hallucination in fact. He may prove not to have been 
in the front trenches at all, or to have come from a 
part of the line not under fire ! 

Then he quickly begins to develop a whole crop of 
curious symptoms, such as no physical injury could 
possibly produce. He becomes suddenly totally 
blind, or deaf, or dumb, with no sign of actual brain 
or nerve damage, and as might have been expected 
after weeks or months completely recovers his sight, 



X 



362 THE DOCTOR IN* WAR 

or hearing, or speech, as suddenly as he lost it. One 
or both of his hands close firmly and can hardly be 
pried open, or his legs suddenly draw up in bed and 
he can't possibly straighten them. 

Commonest of all is a curious twitching of certain 
groups or of most of his muscles, so that he cannot 
hold his head still, or walk or stand, except with inces- 
sant jerkings and tremblings, and if he attempts to 
speak he stutters and stammers in the most appalling 
way. All these jerkings and twitchings are increased 
by excitement. You are brought into a shell-shock 
ward and stop to look at one of the patients. In- 
stantly he begins to stammer and jerk, then the man 
across the aisle follows suit, and the contagion spreads 
in widening circles until the whole ward is set jerking 
and twitching. All the movements and most of the 
spasmodic contractions cease during sleep. 

In fine there is a strong element of what for want 
of a better word we term "hysteria" in this class of 
symptoms. But let it be clearly understood that 
whatever hysteria may be found to mean, it does not 
mean shamming or deiibemte pretense! The poor 
fellows are far too miserable and really ill for that. 

In fact, this second class of shell-shocks clearly 
represent men of defective nervous systems or ill- 
balanced minds who have been thrown off their bal- 
ance by the strains and stresses of war. Some of 
them might have been able to "carry on" and "get 



SHELL-SHOCK 363 

by*' indefinitely in the milder times of peace, but the 
conviction is steadily deepening among mental ex- 
perts that the breakdown of most of them has only 
been hastened by the shock of war. In other words, 
they represent little more than the normal average 
insanity rate among men of military ages. 

One of the most striking features of this war has 
been the tremendous and incessant character of the 
roar and thunder of battle. The world has stood 
aghast at the astounding development of ordnance, 
the unexpected and well-nigh incredible increase in 
the size, range, and number of heavy guns, the 
undreamed-of expenditure of ammunition, and the 
way in which the war has become one of heavy artil- 
lery, the infantry in many cases only going forward 
to pick up the pieces after the big guns have done 
their work. Indeed, preparing the ground for infan- 
try is technically known as "cultivating the soil." 

An army which for nearly twenty years was consid- 
ered well equipped for battle with a few score heavy 
cannon now calls for thousands. More ammunition 
is expended in two days' offensive on the Somme 
than was spent in the whole of the Boer War. Add 
to this that the range of the average heavy gun is 
now about seven miles, and that the really big ones 
can carry up to sixteen and eighteen, so that the 
soldier never knows when he is safe; that all projec- 



364 THE DOCTOR IN WAR 

tiles are explosive, many of them being as tall as a 
man and weighing fifteen hundred pounds, and that 
the crash which they make when they land is like the 
blowing-up of a mine or the explosion of a powder 
factory — and you can form some faint picture of 
the nerve-racking bellow and thunder and roar of 
shell-burst in which the modern soldier has to live 
and fight. The marvel at first sight (and hearing) is 
that even the most iron nerves should be able to stand 
the strain or the best-balanced reason escape ship- 
wreck, or at least grave disturbance. 

Another factor in "frazzling" a susceptible nervous 
system, which is not perhaps quite fully appreciated, 
is the tension produced by the incessant strain of day 
and night watchfulness against shell-fire. In former 
wars a soldier in the open field "went under fire" 
for a few tense, thrilling hours of battle, and then he 
either drove back the enemy or withdrew out of the 
range of his guns. Now he is literally under fire every 
minute of the time, from the moment that he detrains 
at the rail-head to the day that he is lifted into the 
Hospital train for Blighty or his regiment is with- 
drawn for reinforcements and repairs. 

Offensives come and go at intervals it may be of 
months, night raids into the enemy's trenches occur 
weekly, perhaps, in limited areas, but the duel of 
the artillery never ceases. From the time you arrive 
within twenty miles of the trenches you can hear it 



SHELL-SHOCK 365 

booming and thudding and thundering, day and 
night, like the roar of a heavy surf on a rocky coast. 

Moreover, on account of the tremendous reach of 
modern artillery, most of the reserve, or rest camps, 
both in huts and in villages, to which the troops are 
brought back between turns of trench duty, are within 
possible range of the enemy's guns, and he takes excel- 
lent care to remind them of that fact at frequent 
intervals. Hence, in quiet parts of the line, between 
active offensives, it not infrequently happens that 
more men are actually killed by shell-fire, "in their 
beds," so to speak, in the reserve camps, than are 
hit in the first-line trenches. 

In addition to this, the Germans always have a 
few extra heavy naval or other long-range guns with 
which they keep constantly "reaching out'' ten, 
twelve, and even fifteen miles for everything their 
airmen can see which shelters, or looks as if it might 
shelter, any living human creature, whether they be 
camps or villages, forts or churches, hospitals or rail- 
heads. The motto of the Hun at war is, " Kill every- 
thing you can reach, it may help the cause somehow" ; 
and he makes war, not against an army, but a whole 
nation. 

On the other hand, there are certain redeeming 
features of this incessant turmoil and uproar which 
lessen its racking effect upon the nerves. The soldier 
is never, so to speak, at both ends of the flight of a 



366 THE DOCTOR IN WAR 

shell. From the very fact of the tremendous range 
of the guns, if he is in the front-line trenches, for in- 
stance, he practically does not hear the enemy's guns 
which are firing at him, at all, or only as a confused, 
distant roar and rumble. 

On the other hand, his own artillery is some miles 
behind him, so that all he hears of his own guns is a 
moderate boom and roar, with the clear whistle of 
their shells over his head, which on the whole is con- 
soling, rather than otherwise, and helps to steady his 
nerves by assuring him that he is being well supported 
and protected. So all that his ear-drums have to 
stand is the explosion of the enemy's shells as they 
arrive, and these, though bad enough, do not make 
half the fierce concussion and nerve-racking noise of 
the firing of the guns themselves. Besides, so many 
of the shells pass over his head or fall short, or land 
some distance up or down the line from him, that the 
constancy of their arrival in close or dangerous prox- 
imity is not nearly so great as it might be supposed 
from the enormous number incessantly hurled in his 
direction. 

Just as a matter of nerve-straining and head-split- 
ting noise, and an intolerable row and racket, the 
"hottest" place a soldier can get into, is in reserve, 
just in front of, or just behind, his own guns. I have 
been caught there several times myself, and can speak 
feelingly. It seems as if the very breath were going 



SHELL-SHOCK 367 

to be blown out of your body and your head split or 
your hair torn off by the vicious blast and whizz of 
the shells, just two inches above the top of your cap, 
and you think the end of the world is about to come. 
But after twenty or thirty minutes of gasping and 
reeling, you gradually adjust yourself, realize that it 
is not going to kill you after all, or even do you any 
serious damage, and, by and by, you derive a little 
mild consolation from the thought of what this tre- 
mendous roaring and belching must be doing to the 
enemy at the other end of the range. 

In fact, it is quite within the powers of the human 
nervous system to call up its reserves and adjust itself 
even to the murderous and appalling crash and thun- 
der and shriek of modern artillery bombardment. 
Gradually it dawns upon the young recruit that not 
one thousandth part of the horrid and astounding 
racket and roar and crash that he hears means any- 
thing to him personally, not one in fifty of the shells 
that he sees or even hears explode puts his individual 
life in any danger. 

He learns to distinguish instantly and almost un- 
consciously without even thinking about it, between 
the clear, cheery, diminishing whistle of his own 
departing shell, and the hoarse, menacing, crescendo, 
raucous scream of the arriving enemy shell. Indeed, 
incredible as it may seem, the big noise soon comes 
to mean little or nothing to him at all, as no gun that 



368 THE DOCTOR IN WAR 

he can hear is going to touch him and every shell that 
he hears explode has missed him ; for if it landed close 
enough to strike him the fragments would arrive 
before the sound did. The Sinai tical thunder and 
mighty roaring wind of the big guns and the bursting 
shells leave him unmoved. The only thing that tries 
his soul and vexes his nerve is the still, small voice of 
the angry whine of the approaching shell, rising 
swiftly shriller, more threatening, and more personal 
every instant, till it suddenly changes to a delightful 
and soul-relieving diminuendo over your head and be- 
yond, or ends in a dull thud and roar "out of bounds," 
or " off the map," so far as you are concerned. For the 
moment you have the most utter, disgracefully im- 
moral and anti-social indifference as to whom or what 
it may have landed on or hit, so long as it has missed 
you. Even selfishness has its uses and fatalism is a 
positive life-saver when applied to nerve-strain from 
war dangers. 

As the charm of newness and the glamour of dra- 
matic appeal are falling away from shell-shock, much 
of its mystery is clearing up. It is coming to be recog- 
nized as chiefly the revelation of the measure of 
nervous unfitness and mental unbalance admitted 
into our Army. In other words, the number of men 
enlisted who never ought to have been accepted at all ! 

This, of course, does not apply to what might be 

i 



SHELL-SHOCK 369 

described as the " blown-up-and-knocked-down " 
group, who are perfectly normal men, temporarily 
dazed and disabled by a terrific blow on the head. 
These usually recover fairly promptly, except an un- 
fortunate minority who have suffered actual brain 
hemorrhages or other internal injuries. 

But the great body of lasting or permanent shell- 
shocks, who linger on for months and even years to 
try the souls and defy the healing skill of both Army 
doctors and specialists at Base Hospitals, and who 
fill three fourths of the beds in the wards and hospi- 
tals specially set apart for shell-shock, are of a totally 
different type. In the first place, most of them are 
almost as defective physically as they are mentally 
— undersized, under-weight, narrow-chested, shufffe- 
gaited, slack-jawed, with badly shaped heads, irregu- 
lar features, and vacant or restless expressions. Take 
fifty or more of them together and the impression of 
wMat the mental experts term "constitutional inferi- 
ority" is unmistakable. This is confirmed by hun- 
dreds of actual measurements, height, weight, chest- 
girth, muscular power, taken in the larger special 
hospitals for their care. 

In the second place, careful tracing of the previous 
history, both of the patient and his family, carried 
out in over two thousand cases by such eminent 
authorities as Dr. F. W. Mott, of the Maudsley Hos- 
pital, London, show clear proof of previous attacks of 



370 THE DOCTOR IN WAR 

mental disturbance and nervous instability in either 
the shell-shock himself or his near relatives and ances- 
tors in two thirds of all cases. 

Furthermore, these lasting cases of shell-shock 
show a marked "up-and-down " or "circular " char- 
acter, just like ordinary insanity, a tendency to 
periods of improvement, even reaching apparent 
recovery, quickly followed by relapse, usually to a 
little lower level than before. Not a few of the pa- 
tients at the Maudsley Hospital were there for the 
second and even the third time, having recovered 
and been sent to the Front in between. One poor 
fellow, who was pluckily anxious to return, lasted 
just three weeks after he again reached the trenches, 
and another only three days! Which makes rather 
expensive soldiers! 

In fine, a large share of shell-shock is merely 
ordinary insanity occurring in war-time and having 
its delusions colored by the fears of the battle-field 
and given a military stamp. Several common forms 
of insanity begin with what are called "delusions of 
persecution." The patient is firmly convinced, ob- 
sessed in fact by the idea, that certain persons or 
agencies, usually unknown and referred to as "they," 
or "the same lot," are "after him," either with the 
intention of doing him bodily injury or that they are 
spreading all sorts of malicious lies and false reports 
about him among his friends or his fellows or with 
his employers. 



SHELL-SHOCK 371 

If he happens to begin to break down in the camp 
or at the Front, these impersonal, unknown enemies 
naturally become Germans or German spies, or even 
individual German guns, which he will assure you 
with tears in his eyes are specially shooting at him, 
following him about to different places, and have 
only just missed him several times and next time will 
surely "get him." 

One poor boy whom I saw kept coming back to 
camp and reporting most detailed and circumstan- 
tial hair-breadth escapes of this sort from enemy 
shells, when no one else had seen or heard any shells 
fall in, his particular part of the field. His surgeon, 
finding him a nervous wreck, sent him back to the 
Base, and there his hallucinations promptly changed 
to the pitiful idea that he had shown the white 
feather and that " voices' ' were going about inform- 
ing everybody of that fact, so that people stared and 
pointed at him on the street. This so preyed on his 
mind that he finally made a desperate attempt to 
commit suicide and broke down into unmistakable 
insanity. He had made an excellent record for both 
bravery and devotion to duty before the inborn defect 
in his brain began to manifest itself. I say inborn, 
because later inquiries revealed the fact that his 
father had committed suicide while insane. 

Another English soldier who, after several tempo- 
rary attacks of shell-shock, had at last become 



372 THE DOCTOR IN WAR 

clearly demented, was being sent away to an asylum 
from one of the war-hospitals I was visiting. The 
specialist in charge was looking him over for the last 
time and signing up his papers, and, as required by 
law, asked him the question, ''Have you any com- 
plaints to make of your treatment here?" "No," 
said the patient; "no, but I do wish you had taken 
this wireless receiving station out of my stomach. The 
Huns keep sending me the nastiest, most disagreeable, 
and insulting messages through it and I can't stop 
'em! " "Well," said the doctor with a smile at me, 
"why don't you get a pair of clippers and cut the 
wires?" "Ah, I can't do that you know, it's wire- 
less!" Even the hallucinations of the insane have to 
be strictly scientific and up to date nowadays. 

Another young soldier, scarcely more than a boy, 
whom I saw in one of the Base Hospitals in France 
for shell-shock, had settled upon bombs as his par- 
ticular enemy and bete noir. He had walked into the 
Field Hospital after a battle, in a sort of somnambu- 
listic state, and immediately upon being put to bed 
fell into a deep sleep from which it seemed impossible 
to awake him. If liquids were placed in his mouth 
he would swallow them; so he was fed through a 
spouted cup for several days, when it was found that, 
although he would pay no attention to the loudest of 
shouting or vigorous shakings, if food was placed 
close to his nose so that he could smell it, he would 



SHELL-SHOCK 373 

reach out for the plate and proceed to feed himself 
with his fingers, still keeping his eyes firmly closed. 

All sorts of means short of unjustifiable violence 
were adopted to try and bring him out of his hys- 
terical sleep or self -hypnosis, including shouting va- 
rious alarms into his ear, but without the slightest 
effect until it was discovered one day that there was 
just one word to which he would react and fairly 
promptly, and that word was " Bombs." To this 
word he would respond at once and in a most curious 
and definite manner. The doctor, after giving us his 
history, but without telling us what to expect, shook 
the sleeper, shouted his name in his ear loudly and 
flashed a big electric torch in his face two or three 
times without the slightest response. Then he called 
out, in much lower tones than he had used before, 
"The bombs, where are the bombs?' 1 at the same 
time throwing an old briar-wood pipe under the 
bed. 

Instantly the sleeper stirred, lifted himself slowly 
from the pillow, rolled out of bed onto the floor, 
and dived under his cot. There he groped about, still 
with his eyes firmly shut, until he found the pipe, 
threw it out of the window, and crawled back into 
bed again. I say "out of the window," but in reality 
it struck against a screen with which the window had 
been covered, because at the first trial, before it was 
known what he would do with the "bomb," he had 



374 THE DOCTOR IN WAR 

been allowed to pick up a good-sized electric torch 
and hurl it through the glass. 

Evidently he had become vividly in dread of the 
possibility of bombs being thrown into the bay of 
the trench which he occupied, but he had n't even a 
bruise or a scratch on him anywhere, and no history 
could be obtained of his having had any particularly 
narrow or hair-breadth escapes from the explosion 
of a bomb or seeing any of his comrades blown to 
pieces by one. 

Now come the important practical questions, What 
is to be done for shell-shock? and, What is the pros- 
pect for recovery? Obviously neither of these ques- 
tions can be answered in a sentence, for there are 
almost as many different kinds of shell-shock as there 
t are of shocked soldiers; while as for treatment, some 
will recover without anything but a judicious "let- 
ting alone," others will get steadily worse in spite of 
every known and imaginable treatment. However, 
certain broad general lines can perhaps safely be laid 
down, always vividly remembering that few diseases 
follow rigid rules, and that shell-shock seems to con- 
sist chiefly of exceptions. 

In the first place, while recovery is always slow, 
the prospects for regaining a moderate amount of 
comfort and efficiency are fairly good in the great 
majority of cases. Naturally, there is a wide differ- 
ence between the two different classes of shell-shock 



SHELL-SHOCK 375 

patients. Those of the first class, normal, vigorous 
men who have suffered definite physical violence 
from explosion or burying, although it may not have 
actually broken a bone or visibly marked the surface 
of their bodies, have in the nature of the case mucll 
the best chance of recovery. In fact, it may confi- 
dently be expected that two thirds to three fourths 
of them will get well, all, in fact, except those who 
have suffered hemorrhages or other internal injuries 
to the brain or spinal cord. 

It must, however, be remembered that there are a 
good many border-line cases in which the shell-burst 
that actually knocked them down or stunned them 
was only the last finishing touch of a series of war- 
strains both physical and mental, which had been for 
some time breaking down their nervous resistance. 
These, of course, will recover very slowly, and will 
often have great difficulty in reaching a sufficiently 
complete recovery of balance to allow them to return 
to their posts and to continue to stand up under 
the same strains which broke them down before. 
In fact, it may be frankly said, that as a general rule 
it does not pay to send recovered shell-shocks back 
to the Front. Especially as there are plenty of posi- 
tions behind the lines, where they can be of even 
more military value. 

Even in the second class of shell-shocks, those 
unfortunates in whom the war and its dangers and 



376 THE DOCTOR IN WAR 

strains only slightly hastened the time of their break- 
down and determined the character of their delu- 
sions, the prospects for recovery are fairly favorable 
in the majority of cases, though this recovery natu- 
rally will seldom be complete and may not be perma- 
nent. There is an exaggerated feeling of dread and 
aversion to the term "insanity/' which has seriously 
hindered the proper acknowledgment and treatment 
of these cases, because it is believed that the mere 
use of the term is equivalent to sentence of lifelong 
incarceration in an asylum. 

So far from this being the case, fully one third to 
one half of all cases of insanity, even of so advanced 
and clear a type as to be admitted to an asylum in 
times of peace, recover in the sense of being able 
again to maintain and take care of themselves in the 
battle of life. And in the case of these breakdowns in 
the soldiers, we have the great additional advantage 
of being able to give them a complete and striking 
relief from the strains which have proved too much 
for their balance, and a most radical and restful 
change of scene merely by withdrawing them from 
the Front and sending them well back to the Base, 
or, still more, to England. There careful psychic re- 
educational treatment with baths, massage, tonics, 
etc., will often make them most useful soldiers again, 
though seldom for front-line duty. 

While a good many of this class of shell-shock cases 



SHELL-SHOCK 377 

were probably already on the down grade mentally, 
and it was only a question of time when the final 
collapse would come, not a few of these war-wrecks 
would probably have stood the wear and tear of busi- 
ness and civil life for a considerably longer period, 
or perhaps indefinitely. And this class stand a good 
chance of recovery by being sent back to civilian life. 

On the other hand, it might be said in passing that 
there is ground for the paradoxic belief, that while 
war-strains break down a certain number of un- 
sound nervous systems earlier than normal, they 
appear to stimulate and build up and postpone the 
breakdown of other cases with poor nervous stability. 

The one consoling fact of all this business of shell- 
shock and war-strain is, that when all is said and 
done and its seriousness and unmanageableness fully 
recognized and every known case listed and counted, 
the sum total of all classes which last more than two 
months is little more than the average " normal " per- 
centage of insanity among men of military age in 
times of peace: that is to say, about two per thou- 
sand of the total forces on the Western Front. 

A similar process seems to be taking place among 
the civilian population at home, for while in the 
beginning of the war there was a slight temporary 
increase in the number of admittances in the hospi- 
tals for the insane in England, this was completely 
balanced by the end of the first year, and for the past 



378 THE DOCTOR IN WAR 

two years there has actually been a falling-off of over 
two thousand cases per annum in the number of 
commitments to asylums. 

In the autumn of 1917, for instance, I found that 
the total number of all cases of shell-shock in the 
military hospitals in England was 2760. And this 
represented the accumulations of three years of war 
— less those passed on to insane-asylums — from 
an army of at least five million men. 

Shell-shock is one of the rarer and least important 
of the wrecks of war. 

A similar process in less degree took place in France. 
What apparently happened was, that the first terrific 
shock and upheaval of the war upset promptly all 
those who were near the point of a mental break- 
down. But later the new interests and responsibili- 
ties, the new enthusiasm of patriotism and devotion 
to the common welfare created by the war, lifted the 
nervously depressed out of themselves and enabled 
them to get a new grip upon life and sanity. This was 
probably also felt in the working classes because of 
the abundant employment, for even unskilled indi- 
viduals of all grades of capacity had high wages, which 
both gave them a more cheerful outlook on life and 
enabled them to feed themselves and house them- 
selves much better. 

In other words, civilized man evidently still pos- 
sesses wide powers of adjustment and has succeeded 



SHELL-SHOCK 379 

in meeting and accommodating himself to even the 
terrible strains and griefs and hardships of this 
colossal war in the most surprising and gratifying 
manner. This is particularly noticeable among the 
men out at the actual Front. From Ypres to the 
Isonzo, from the Somme to Verdun, wherever one 
strikes it, one is instantly impressed with the fact 
that the Front is far and away the most cheerful 
region to be found anywhere in this war. Instead of 
being depressed by their hardships and dangers, the 
actual fighting men, whether Tommies, Anzacs, 
Poilus, Alpini, Yanks, or Bersaglieri, seem to be exhil- 
arated by them. Life may be short and uncertain, 
but that shall not make it unhappy while it lasts. 



XXI 

THE HEALTH OF THE AVIATOR: SAVING 
THE BIRD-MAN FROM EXTINCTION 

FOR all its hugeness and complexity there is only 
one really new thing in this whole world-war, 
and that is air righting. At first sight poison-gas 
might seem to be another, but, as a matter of fact, 
it is as old as it is vile, and traces its malodorous 
ancestry back to the Oriental stink-pots and the 
Greek fire, to say nothing of the cuttlefish, the bom- 
bardier beetle or stink-bug, and the black-and-white 
midnight ravisher of our hen-roosts. War has be- 
come, not merely terrestrial and aquatic, but celes- 
tial as well. For the aeroplane has carried it up into 
the heavens above, as the dug-out and the mine have 
carried it into the earth beneath, and the submarine 
into the waters under the earth. 

Being new, the airman was and is yet a good deal 
of a puzzle to the professional military mind. There 
was first of all great difficulty in correctly placing or 
classifying him as to the arm of the service to which 
he belonged. He obviously did not march on foot, so 
he was n't infantry; he did not ride on a gun-carriage, 
therefore he could n't be artillery. But he did mount 
a steed of some sort, even if only a winged one, a 



THE HEALTH OF THE AVIATOR 381 

Pegasus ; therefore he belonged to the cavalry. Con- 
sequently, through all the earlier years of the war, 
the aviator clanked about with spurs on his heels, 
which were just as useful to him as the proverbial 
second tail to a cat. 

The airplane service, though it is new and will 
probably win the war in the end, has made, on 
the whole, the slowest and the most unsatisfactory 
progress of any arm of the service. Infantrymen — 
splendid ones, but of the same old brand that have 
been used in every war since the invention of gun- 
powder — have been turned out by the million ; 
cavalry, by the hundreds of thousands, of the type 
that Attila used, and, as cavalry, just about as use- 
ful in the first three years of the present war as so 
many perambulators; cannon, by tens of thousands; 
while airplanes, which are the most hopeful chance 
of doing something new and decisive in the war, 
have, after four years of war, been turned out in 
only hundreds or even tens, although the cost of 
one is barely that of the useless chargers required 
for half a troop of cavalry. 

One of the few disappointments of my six months' 
succession of visits, covering at least two thirds of 
the Western Fronts, including the Italian, was that 
the highest number of airplanes that I ever saw in 
the air at any one time was sixteen, and the largest 
squadrilla of planes, in regular formation and moving 



382 THE DOCTOR IN WAR 

as one, was nine, seven Capronis and two Nieuports 
sailing majestically over the Carso into the sunset to 
bomb Trieste. 

On the other hand, I saw everywhere thousands of 
splendid cavalry horses doing the grasshopper act; 
that is to say, eating their heads off, and absorbing 
the services of nearly a third of their supposed riders, 
the other two thirds, after having been mounted and 
equipped to ride, regardless of expense, being dis- 
mounted, and used in the trenches as infantry. And 
when the Ministry of Food was created in England, 
and the people were urged to use as much as possible 
of oats and barley in the place of the precious wheat, 
it was discovered that there practically were no oats 
left, because they had all been bought up by the Army 
Commissariat Department for the use of the cavalry 
horses in France, and what few were left were more 
expensive than wheat. And there was shortage of 
barley, because most of it had been fed to the cattle 
and pigs and poultry to make up for the shortage of 
oats and wheat offal. 

But then no respectable war, of course, could 
possibly be conducted without cavalry, and it is 
almost pathetic to see the eagerness with which the 
generals, the moment that the battle gets out into 
the open for a few days, jam a few troops of cav-^ 
airy into the melee by main force and then turn 
round and proudly remark, "There, we told you 



THE HEALTH OF THE AVIATOR 383 

they would come in useful sometime if you only 
waited." 

There was a story going the rounds among the 
Tommies when I was at the Front, to the effect that 
some one had actually had the temerity one day to 
ask a howling swell of a cavalry officer, what use the 
cavalry had actually been in this war. "My dear 
boy," said the exquisite, with an air of wearied con- 
descension, "it has been simply of priceless value by 
giving tone and class to what would otherwise have 
been a mere vulgar brawl." 

But the airplane has forged ahead after a sort, in 
spite of its being the Cinderella of the General Staff, 
though the darling of the general public, whose mili- 
tary instincts are often surprisingly sound. It devel- 
oped certain internal difficulties of its own, chief 
among which was its astonishing infant mortality, 
equaling that of the vilest city slum ; from twenty- five 
to fifty per cent of those who were "born" into its 
realm dying within the first year of flying life. The 
grimly pathetic epigram attributed to Guynemer, 
the ace of aces, that the successful [flyer won first 
the Croix de Guerre, then the cross of the Legion of 
Honor, then the wooden cross, had a most painful 
amount of truth in it. The life of an aviator was vari- 
ously alleged to be anywhere from three days to three 
months after he had fairly learned to fly. And what 
was worse, the mortality in training was said to be 



384 THE DOCTOR IN WAR 

almost as great as that in actual fighting and scout- 
ing. It really looked as though the war plane had 
settled the much-debated scientific problem as to 
why the flying lizards and dragons and other winged 
monsters of antiquity had become extinct. 

For a long time this was regarded solely as a matter 
of the newness of the art of flying, the tremendous 
strains to which the planes were subjected, and on 
top of this, of course, the risks of war. It was danger- 
ous enough just simply to fly in most weathers with- 
out having to run the risk of being potted by Archies 
and other anti-aircraft guns, to say nothing of enemy 
aviators. 

But by great good luck the doctor was finally 
called in consultation, after some hundreds of the 
patients were already dead, and it was discovered, 
much to every one's surprise, that a very large share 
of this distressing and disabling mortality was due, 
neither to the enemy's fire, nor to engine trouble, nor 
to defects in plane construction, but to accidents 
occurring inside the flyer himself. A joint commission 
of Allied experts was appointed to investigate a 
series of some hundred successive deaths of airmen, 
and reported the significant and astonishing finding, 
that a very large percentage, indeed an overwhelm- 
ing majority, of them were due to heart failure, loss 
of consciousness, or other sudden breakdown of the 
aviator. 



THE HEALTH OF THE AVIATOR 385 

Here evidently is most promising work for the 
doctor, and while, of course, this single set of find- 
ings is but a straw, even if future returns from our 
rapidly widening experience should cut in two the 
tremendous preponderance, it would still leave the 
risks of air fighting chiefly a medical problem; as 
largely so almost as were the old-time general war 
mortalities when six sevenths of all deaths in an 
army were due to disease: with the cheerful out- 
look that the present high life-risks of the flying 
man may be cut in two, if not to a fourth or a fifth 
of their former deadliness. 

At all events, there cannot be the slightest doubt 
that all the possible resources of medicine and the 
allied sciences should be immediately called into 
action and concentrated on the problem of improving 
and protecting the health of the flying man. And this 
is why army doctors have been so eagerly urging, 
what has just recently been granted, the formation 
of a special Aviation Medical Corps, which shall 
have absolute and continuous control of the health 
and welfare of the aviator from the time that he 
comes up for admission to the service till he becomes 
a candidate for the wooden cross and needs "warn- 
ing off" to save his life. 

Although these findings of the tremendous part 
played by the health of the bird-man in his death risks 
astonished even the doctors, yet it fitted in with and 



386 THE DOCTOR IN WAR 

explained a number of other rather puzzling results 
of their experience. 

One was, that there did n't seem to be any even 
approximately "accident-proof" type of airman. 
No matter with what flying colors a candidate had 
passed all his entrance tests, no matter how swiftly 
he became at home in the air, how completely he 
seemed to be a born flyer, for whom neither altitude, 
nor side slips nor nose dives had any terrors, sooner or 
later, one day, flying under perfect air and weather 
conditions, his machine would be seen suddenly to 
go out of control and come crashing downward, 
either to a fatal smash or perhaps to recover itself 
by a desperate effort within fifty or a hundred feet 
of the ground. 

If the flyer survived, the only light that he could 
throw upon the accident would be, perhaps, that he 
began to feel sick at his stomach or commenced to 
turn giddy, or that his machine suddenly seemed to 
plunge out from underneath him, or, quite frequently, 
that he remembered nothing at all from the time 
that he was spinning along in perfect balance until 
he was being pulled out of the wreck of his machine 
or found himself in a hospital cot. 

At first these unaccountable collapses were ascribed 
to the so-called "holes in the air," or small areas of 
lower density in the atmosphere due to vertical up- 
ward or downward currents of air, into which the 



THE HEALTH OF THE AVIATOR 387 

aeroplane "bumped" as a wagon might into a deep 
rut or chuck-hole. But it seemed rather difficult 
to prove the existence of such pitfalls on other 
grounds, and even if they existed as surmised, they 
would not have accounted for the commonest and 
most constant feature in the aviator's account of his 
mishap, a temporary loss of memory or of conscious- 
ness. 

Then they were laid to a mysterious alleged "air- 
sickness," similar to the allied and familiar sea- 
sickness, and due like it to sudden changes and 
pitches in the equilibrium of the sufferer. But this 
again was found to be largely mythical, certainly at 
least in the sense of its being an experience which a 
majority of aviators had to go through in learning 
to fly, as the embryo sailor or the midshipman has to 
suffer the tortures of sea-sickness before he acquires 
his sea-legs. When we came to send up flyers by the 
scores and the hundreds, it was soon found that the 
majority of them never suffered from this balancing 
"air-sickness" at all — that is to say, not until they 
came to soar to high altitudes, when they encoun- 
tered "air-sickness" of another sort; while, on the 
other hand, expert and seasoned flyers would be sud- 
denly attacked by nausea and giddiness without any 
apparent cause, so far at least as their evolutions or 
the air conditions were concerned. In fine, all we 
could say was that a very considerable share of acci- 



388 THE DOCTOR IN WAR 

dents in the aviation field were due to some mysteri- 
ous cause affecting the aviator himself, and could 
not apparently be accounted for by plane defects, 
weather, or the stunts which he was attempting. 

Then another side-light was thrown upon the 
problem from a grim and pathetic angle, and that 
was the remarkable frequency with which aviators 
would feel and express premonitions of disaster just 
before going up for their final and fatal flight. Some- 
times it would be a mere remark to some of his com- 
rades or officers, that he believed the Boches were 
going to get him this time; sometimes the statement 
that he had n't slept very well and had had dreams 
of disaster, or that his head was feeling queer or his 
stomach uncomfortable, and he did n't believe he 
would be able to play up to his usual standard that 
day. But in other cases the premonitions seemed to 
have been so definite and convincing that they actu- 
ally left letters or special messages for their relatives, 
or even instructions to their comrades as to what 
was to be done with their belongings if they hap- 
pened to be "out of luck" that day. 

Of course, many of these intimations of impending 
trouble have to be accepted with a good deal of cau- 
tion and deduction. Even the bravest and most 
expert of soldiers or other men, when starting out to 
take a serious risk, have attacks of depression and 
foreboding, most of which come to nothing at all, 



THE HEALTH OF THE AVIATOR 389 

and for every prophetic or "second-sight" warning 
of disaster which comes true, there are probably at 
least ten or a dozen which happily prove entirely 
unfounded. 

But we doctors have gradually come to regard a 
sense of impending death, especially early in a case 
of illness, or even, as sometimes happens, a day or so 
before the disease breaks out in open form, from a 
somewhat different point of view than that of pro- 
phecy or "second sight." While many of them fortu- 
nately fail to come true, those which do can be shown 
in a very considerable percentage of cases to rise out 
of the state of mental depression caused by the first 
flooding of the patient's blood with the toxins of the 
disease. In other words, they are the first symptoms 
of the disease itself, instead of any prophetic intima- 
tion of its approach beforehand. 

These intimations and premonitions of the avia- 
tors fall very decidedly into this last category of 
coming events, which literally cast their shadows 
before by the impression that their first and advance 
attack makes upon the sensitive nervous system of 
their victims. And as soon as we began to question 
more carefully from this point of view the aviators 
whose accidents fortunately did not prove fatal, we 
found abundant evidence pointing in this direction. 
One flyer had noticed that he had n't much appetite 
for breakfast, and what little food he ate seemed to 



390 THE DOCTOR IN WAR 

disagree with him, and by the time he had got up 
only a few thousand feet into the air, he became 
nauseated, giddy, and momentarily lost control of 
his machine. Another complained before starting 
of a headache, which he attributed to being up too 
late the night before or perhaps smoking or drinking 
a little more than he should, and when he was per- 
forming one of his simplest stunts, his head began to 
throb, his hands seemed to become numb, and his 
"bus" went out from under him — and landed him 
in the hospital. 

The higher he soars, the greater becomes the mag- 
nification of his trouble, so that apparently a dis- 
comfort or disturbance, which would have been no 
more than annoying and uncomfortable if he had 
remained on earth, is multiplied into a blinding or 
disabling disturbance ten thousand feet up. 

In fact, one instance at least has been furnished of 
the actual demonstration of how a mere trifling dis- 
turbance on the ground may be turned into a serious 
interference with balancing power at a higher alti- 
tude, in one of our Air Board laboratories. It has 
been found that a large share at least of the disturb- 
ances, dizzinesses, etc., caused by high altitudes, is 
from the lack of oxygen due to the lowered air pres- 
sure. Consequently, candidates for the Flying Corps 
can be tested as to their ability to stand high altitudes 
merely by putting them into a large vacuum chamber 



THE HEALTH OF THE AVIATOR 391 

^ and gradually exhausting the air with a pump to the 
degree of thinness which would be found at an alti- 
tude of eight thousand, ten thousand, fifteen thou- 
sand feet. Two expert observers usually go into the 
vacuum chamber with the candidate and stand one 
on each side of him to keep track of the pulse, blood 
pressure, and general condition, so as to give warning 
when he is approaching any danger of collapse ; they 
being supplied with tubes in their mouths through 
which they can inhale oxygen, are able to work in 
almost perfect comfort. And it is quite a curious 
contrast to watch the labored breathing and the pale 
or flushed countenance of the candidate, as the pres- 
sure is lowered, while the experts on each side of him 
remain fresh-colored, breathing easily, and com- 
pletely absorbed in their observations. 

But one morning, one of the observers had n't 
cared much for his breakfast, and what he did eat 
did n't seem to agree with him, and after he had been 
in the vacuum chamber with one candidate after 
another for an hour or so, he began to feel an un- 
comfortable sense of tightness and constriction about 
his waist-line. Almost without thinking what he was 
doing, he most injudiciously unbuckled his belt and 
unbuttoned the two upper buttons of his trousers, 
when immediately, under the extremely low pressure 
at which he was working, his stomach, as he expressed 
it, "bulged up like a balloon " and caused him such 



392 THE DOCTOR IN WAR 

acute discomfort that he had to signal to be let out 
of the chamber. 

What had happened was, that the acid fermenta- 
tion of the food in his stomach had caused the pro- 
duction of a certain amount of gas, which at ordinary 
air pressure would merely have made him slightly 
uncomfortable. But as soon as the pressure of the 
air in the chamber had been reduced below that 
of the gas in his stomach, it proceeded to balloon 
up and cause painful distention of its walls, which 
might, if he had been actually flying and still rising 
higher, have produced very severe pain and even 
unconsciousness, before he realized what was the 
trouble. 

Of late the same tests can be made, without the 
expense and trouble of a vacuum chamber, by al- 
lowing the candidate to exhaust the oxygen out of 
the air of a container by simply breathing it over 
and over again till its rarity corresponds to ten 
thousand, fifteen thousand, twenty thousand feet of 
altitude and noting the results. 

The evidence is overwhelming that one of the great 
mottoes both of the aviator and his Army doctor 
should be, "Despise not the day of small things." 
The same gospel was already being preached by the 
experts connected with our Air Board laboratories 
and testing-stations. As every one knows, candidates 
for admission to the Flying Corps are put through 



THE HEALTH OF THE AVIATOR 393 

about the severest "third degree" of an examination 
for physical fitness that can well be imagined: not 
merely the ordinary Draft Board tests for soundness 
of heart, lungs, limbs, nerves, and senses, but a whole 
battery of special tests, of eyesight, of hearing, of 
balancing powers, or capacity to stand high altitudes, 
and a full series of psychologic tests to try out their 
mental and emotional possibilities. 

In the beginning and for a considerable time after 
it was believed, not unnaturally, that the aim and 
result of all these tests would be to pick out among 
thousands of applicants a few score or hundreds of 
exceptional men peculiarly fitted for the new and 
unconquered field of the air, a sort of human bird, 
as it were, men who did n't know what the fear of 
falling was, whose balance centers or semi-circular 
canals could not be disturbed or dizzied by any 
amount of whirling blindfold on spinning tables, and 
who would not gasp for breath at the highest alti- 
tudes, men who were born to fly as the fish is to swim. 

But gradually, as experience in the new and un- 
tried field piled up, it was found, first of all, that this 
type of born flyer who could stand any amount of 
altitude and whirling and looping was a distinctly 
rara avis — without any pun being intended. Sec- 
ondly, that when this fortunate freak or prodigy was 
discovered, he was almost as liable to sudden and 
unaccountable accidents and mishaps as any one else. 



394 THE DOCTOR IN WAR 

Third, and most important, that any vigorous, 
healthy, intelligent young chap, with a sound heart, 
a good pair of lungs, a healthy digestion, and normal 
eyesight, hearing, and balancing powers, could learn 
to fly within ten days and develop into a perfectly 
competent average aviator. To make an ace requires 
a touch of genius, but for nine tenths of the routine 
work which an aviator is called upon to do — bomb- 
ing, photographing, observing, fighting in regular 
formation — all that is required is sound health, 
keen senses, and good average judgment and intelli- 
gence. "A man wid two hands an' two feet an' all 
his teeth in his head," as Mulvaney puts it. The 
Navy experts frankly declare that almost any man 
who can drive an automobile can learn to fly. 

So that while not relaxing the thoroughness of their 
examination, the Air Board experts are, so to speak, 
rationalizing their standards, feeling that they will 
get better results by admitting vigorous, healthy, nor- 
mal young men, putting them under ideal physical 
conditions and the most watchful observation of the 
doctor, and then completing their test by actual 
experience in the air itself. First, in the "dummy" 
machines, which skim about in all directions over 
the field, but never really leave the ground for more 
than a few yards at a time; then in a double-seater 
with an experienced pilot and coach, and weeding 
out ruthlessly those who do not quickly become at 



THE HEALTH OF THE AVIATOR 395 

home in the air and lose practically all fear of it in a 
week or ten days, or who seem to have difficulty in 
keeping cool and clear-headed and meeting easily 
and enjoyably the ordinary emergencies of simple 
flying. 

If the doctor is "strictly on the job," the risks of 
this preliminary probation would be slight, and it 
would result in the prompt weeding-out of a certain 
number of men who for their own best good, as well 
as that of the service, ought not to be allowed to fly 
at all. It seems to be the unanimous opinion of avia- 
tion physicians and experts in all the Allied countries 
that there is a certain percentage of men with perfect 
physical health, and who can pass all the most rigid 
tests for sight, hearing, balancing powers, etc., yet 
who can never learn to fly with either comfort or 
safety. If this type were keenly watched for and 
promptly weeded out within the first two or three 
weeks, and the much larger proportion of candidates 
who take to the air easily and readily were kept under 
constant expert observation, and never permitted 
to fly either in training or actual war work except 
when they were in perfect physical condition, it is 
believed that a very large majority of the fatal risks 
of flying would be obviated entirely. 

Most aviators of experience are quite well aware 
of the dangers of going up when not physically fit. 
They enjoy life and its pleasures as keenly as any 



396 THE DOCTOR IN WAR 

other healthy, high-spirited youngsters, but most of 
them decline to smoke when on active service, and 
many of them abstain from alcohol altogether for 
days before a flight, or, if from the wine-growing 
countries, take only most abstemious amounts of the 
lightest of vintages. Though they are left almost 
entirely to their own discretion in these matters, they 
have found that late hours and burning of the candle 
at both ends of all sorts simply do not "consist " with 
that perfect clearness of head and keenness of judg- 
ment which is absolutely necessary to safe and suc- 
cessful flying. 

In fact, the code of the aviator has become that of 
the athlete, raised to the nth power, clean, cheerful 
living, self-restraint, self-control, well repaid by the 
exhilarating sense of fearlessness and fitness for any- 
thing. Their chief dread is of nervous exhaustion, 
which shows itself in the form of worrying and lack 
of confidence, and inability to judge distances prop- 
erly. Its first warning symptoms are bad dreams and 
nightmares, usually connected with the risks of their 
work, among which machine guns jamming and two 
Boches "diving on your tail" are the most frequent 
and significant. When these visions begin to make 
night hideous, they know that their only safety lies 
in two or three days of complete rest. Warnings 
which come in dreams are usually regarded with well- 
merited suspicion, but in this particular case they 



THE HEALTH OF THE AVIATOR 397 

seem to be painfully liable to "come true" in the 
shape of an accident or mix-up, if their danger signal 
is disregarded. 

Another potent way in which the safety of the 
bird-man can be guarded is by the intelligent use of 
oxygen. When the aviator spirals up to an altitude 
of eight or ten thousand feet, he comes into the 
danger zone of what has long been known as "moun- 
tain sickness." This is an extremely distressing and 
uncomfortable condition, of intense depression and 
sense of muscular weakness often accompanied by 
nausea, vomiting, and giddiness, which attacks those 
who climb high mountain peaks. 

Ever since men began to climb high mountains or 
to go up in balloons, it has been known that above 
a certain altitude they became subject to various dis- 
comforts, as shortness of breath, pain in the ears, 
and sensations of giddiness from changes of pressure 
upon the ear drum, and hemorrhage or bleeding from 
the lips and throat or from the ears, due to the sudden 
lowering of the pressure upon the blood vessels near 
the surface. That these changes were due to the 
rarity or thinness of the air on account of the fact 
that its pressure steadily diminishes as one climbs 
upward from the sea-level was early recognized, but 
it was always a problem as to how much of it was due 
to direct action of the lowered pressure upon the 
body surface and the blood in the blood vessels, and 



398 THE DOCTOR IN WAR 

how much to the lowered pressure of oxygen, and 
consequently smaller amount of this most vital gas 
which could be drawn into the lungs at each breath. 

Recent investigations, however, both by a group 
of American scientists in their famous expedition up 
Pike's Peak, and by Italian and French experts, have 
shown that the lion's share and probably the over- 
whelming majority of all the most distressing and 
disabling of these symptoms are due to the lack of 
oxygen alone and can be avoided or prevented by 
judiciously inhaling a supply of the gas from a cylin- 
der or the container. This is a finding of immense 
practical importance, because, obviously, if what has 
been proved in high mountain altitudes holds good 
for the same altitudes in aviation, then by supplying, 
with cylinders of oxygen and a proper inhaling mask, 
all flying machines which are expected to go above 
eight or ten thousand feet, another very considerable 
share of the risks and dangers of high flying can be 
either prevented entirely or very considerably dimin- 
ished. Experts upon both sides of the battle-line are 
now actively engaged in testing out this question 
and in devising some form of container which will 
combine lightness with bullet-proofness, and an 
inhaling tube or mask which will properly regulate 
the supply of oxygen for the airman. 

The problem is a difficult one, partly because space 
in the narrow body of the fuselage is already at the 



THE HEALTH OF THE AVIATOR 399 

highest possible premium, and every available gap 
or angle of the airplane is packed and crowded with 
controlling or fighting or protective mechanical de- 
vices of every imaginable sort; partly because the 
wearing of a mask through which to inhale the oxy- 
gen would be likely to interfere a good deal with the 
freedom and fighting powers of the airman, while, if 
inhaled directly through a tube, it would have to be 
kept flowing at very low pressure or else considerably 
diluted with some other bland gas, in order to pre- 
vent irritation and even mild burning of the mouth 
and throat. 

But in the bright lexicon of science there is no such 
word as fail, and if it is shown that the proper use 
of oxygen will prevent much of the stress and heavy 
wear and tear of flying at high altitudes with frequent 
changes, and will diminish the aggravation of com- 
paratively slight disturbances of health into dis- 
abling distresses high up in the air, some apparatus 
will unquestionably be devised for supplying our 
flyers with oxygen. So far as tests conducted in the 
vacuum chamber on the ground are concerned, it has 
already been pretty conclusively proved, both by 
Italian and American investigators, that at least 
three fourths of the sensations of discomfort, faint- 
ing, nausea, etc., can be completely prevented and 
abolished by the use of oxygen. An Italian expert 
has even been able to stand with perfect comfort a 



400 THE DOCTOR IN WAR 

lowering of pressure corresponding to an altitude of 
over forty thousand feet, simply by inhaling a gas-, 
mixture of oxygen and carbon dioxide, the other gas 
which is present in our blood. This elevation, of 
course, is far above anything ever yet achieved by 
either mountain climbers — for the very good and 
sufficient reason that there is n't anything high 
enough for them to climb on to that level — or 
aviators. 

That the height, of the flying has a marked effect 
upon the risks of the bird-man is most strongly sug- 
gested, if not actually proved, by the almost appalling 
table of "life expectation," worked out by a combina- 
tion of English and American air experts, of the dif- 
ferent classes of flyers. At the top, in the double 
sense of nearest to heaven and most liable to ascend 
to it at any moment, comes, as would have been 
expected, the combat man or fighter, who has to fly 
at heights ranging from sixteen to twenty- two thou- 
sand feet, and whose average "life" is from one hun- 
dred to three hundred hours of actual flying, which 
means from one to three months. I must hasten to 
explain, however, that the term "life " does not mean 
the literal physical life of the aviator himself, but the 
length of time which he can, as the saying is, last in 
the air, after which he is extremely likely to meet 
with some disabling or fatal accident, or, if his guar- 
dian physician and superior officers are properly 



THE HEALTH OF THE AVIATOR 401 

alert, to be transferred into some other branch of the 
service or to a staff position or a post as instructor. 

Next comes the observer flying at from, ten to six- 
teen thousand feet, and whose "life" is considerably 
longer, namely, from three hundred to six hundred 
hours of flying, or from three to six months. Last and 
safest of all comes the night bomber, whose particular 
task requires only peaceful altitudes of from five to 
ten thousand feet, and whose "life," though less 
exciting, is noticeably and gratifyingly longer, namely 
from seven to nine months. 

Altogether, the outlook for the flying man, the 
warrior of the future, is very much less serious and 
more hopeful than was at one time feared. What his 
actual mortality up to the present is and has been is 
jealously preserved as a military secret, so that it is 
difficult to make any definite prediction, except to 
say that we may confidently expect a marked reduc- 
tion of it in the near future. 

First, by developing a system of aerial medicine 
and training an aviation medical corps, and put- , 
ting the welfare and the interests of the bird-man 
absolutely and entirely under their control from the 
time that he presents himself for admission to the 
service. Second, by improving and rationalizing the 
present series of tests and extending it to include 
mental, emotional, and judgmatic powers, y/ and giving 
each candidate a thorough practical try-out in the 



402 THE DOCTOR IN WAR 

air under the most vigilant supervision, both med- 
ical and aeronautic, before deciding upon his admis- 
sion or rejection. Third, by the utilization of oxygen 
as a preventive of some of the most serious risks of 
air-sickness and other conditions liable to cause loss 
of consciousness. Last, but not least, by having the 
aviation doctor live with and "mother" him as a 
trainer does with his crew or team; watching him like 
a hawk for the slightest appearance of trouble or 
deviation from normal balance, and then absolutely 
forbidding him to fly except when in perfect condi- 
tion. This will mean the having in reserve, as it 
were, a somewhat larger number of men for each 
given number of machines, so as to be sure that there 
will always be a sufficient number of competent flyers 
in proper condition for flight. But there can be no 
question that it will result in the checking of a most 
pitiful waste of splendid young life and the reduction 
of the risks of the bird-man in his new element to less 
than half if not less than one fourth of their present 
level. 



XXII 

THE UNIVERSITY OF THE ARMY: WAR 
AS A COLLEGE COURSE 

WAR is the oldest game in the world, but the 
rules are always changing. On account of its 
dramatic appeal and our age-long ancestral worship 
of courage as the supreme virtue, our imagination 
persists in thinking of the war game as if it were still 
played according to the rules of the last century or 
the century before last. 

So deeply have historic and other forms of roman- 
tic literature impressed upon our mind's eye the 
picturesque aspects of warfare that we simply cannot 
rid ourselves, in spite of the evidence of our senses, 
of the idea of war as a matter of flying colors and 
glittering accoutrements and dashing cavalry charges 
with waving of swords and shouting of war-cries. 

When we send forth our boys to do their part in 
making the world safe for democracy and keeping 
life worth living in the future for those who would be 
free, we are apt to think of them as going into a world 
totally different from their past, where their sole aim 
and occupation will be risking their lives trying to 
kill other men or to keep other men from killing them. 
Something which has not only no connection with 



4 04 THE DOCTOR IN WAR 

their past, but no bearing upon or relation to their 
future life and work after the war is over. 

As a matter of actual fact, probably less than ten 
per cent of their time will actually be occupied in the 
dangerous and exciting duty of actual fighting. And 
while the whole of their training and cooperative 
activity and mental teamwork is directed toward 
"this brief, fierce hour of glorious life" and getting 
the better of the enemy, yet the means which are 
employed in leading up to this crushing blow on the 
enemy's lines are the very latest and most up-to-date 
forms of modern, industrial, and social organization 
and scientific efficiency. 

Modern war has become one vast engineering and 
reclamation enterprise with a fighting edge on it. 
Every human faculty and gift and power which is 
useful in peaceful life will find its field and scope and 
occupation in modern war. As Sir Auckland Geddes, 
England's Director of National Service, has recently 
put it, "Every man who is capable of earning a living 
in peaceful life can be made use of in a modern army." 

In the first days of the war, when the crying need 
was to rush forward some sort of a human barrier 
against the devouring Prussian flood, there was no 
time for making distinctions of capacity and special 
fitness. Any one who was brave enough to offer his 
life for the defense of his country, and physically fit 
and vigorous, was eagerly and gladly accepted, and 



THE UNIVERSITY OF THE ARMY 405 

sent out to the firing-line with as brief a delay as 
possible for obtaining an equipment. But as soon as 
the war had settled down into its form and the real 
nature of the seriousness of the struggle became ap- 
parent, an actual combing-out had to be made of the 
regiments on service at the Front for the purpose of 
bringing back the men who had special mechanical, 
engineering, and scientific training, for the purpose 
of putting them into munition factories and on the 
railroads and on the telephone and telegraph lines 
supplying and supporting the armies at the Front. 

So new and unforeseen was this demand of modern 
war that even in Germany hundreds of thousands of 
men were withdrawn from active service at the Front 
to go back to munition factories, electrical and chem- 
ical works, and later even to special branches of agri- 
culture, in order to keep the fighting-line supplied 
with the sinews of war. As Lloyd George declared 
not long ago in Parliament, " It takes three and four 
women at home on the land, in the mines, in the shops, 
and on the railroad to maintain and supply one man 
on the fighting line at the Front." 

Nowadays when a man is enlisted or conscripted 
for service a careful inquiry is made as to his previous 
training, experience, and aptitude, so as to see for 
what particular group of the innumerable callings 
which go to make up the modern army he is best 
fitted. If he knows how to run and repair a car, he 



406 THE DOCTOR IN WAR 

will very probably be enlisted at once in one of the 
various branches of the transportation service. Next 
to the railways long lines of motor lorries and trucks 
bearing food, supplies, and ammunition are the literal 
life-blood of an army, without which its striking mus- 
cles would quickly fall paralyzed and helpless. 

If he has had experience in the Big Woods he may 
be drafted into one of the army lumbering gangs, 
which with portable sawmills are invading the ancient 
forests and woodlands of France and cutting down 
and sawing up the monarchs of its glades to make 
barracks and sidewalks and trench revetments for 
the Allied troops. Thousands of Canadian lumber- 
jacks have been specially enlisted in the Army for 
this purpose, and you hear the whirr of their saws 
and the ringing of their axes in the historic woods 
and beautiful groves all over England, sacrificing the 
oaks of the Druids and the sheltering groves of the 
noblest mansions, for the defense of freedom. 

Should he have had familiarity with electrical 
installations or with telephone or telegraph work, 
there is a whole range of berths in these Intelligence 
and Signal Services which are open to him. Not only 
are new lines of communication being constantly 
built, but unlike in civil life the old lines will not stay 
put, but are continually being destroyed and inter- 
rupted so that a continuous exercise of ingenuity in 
reconstruction is constantly necessary. 



THE UNIVERSITY OF THE ARMY 407 

If he knows anything about pumps, or mining, or 
drainage or water-supply, he will be eagerly snapped 
up by either military engineers or sanitary officers 
and employed upon vitally important military serv- 
ice, even though it has nothing directly to do with 
participation in the actual fighting. 

Has he "an eye for country" or some experience 
in surveying and knows how to draw maps and plot 
out contour lines, there is a wide field for him in the 
surveying department of the various headquarters 
staffs. 

Should he prove an adept in the greatest and most 
important of all arts, the handling and moulding and 
controlling of men, there are a score of eyes constantly 
upon him to detect the first blossoming of ability in 
this direction. And his rise in rank on an average 
will be found to be as rapid and as free from personal 
favoritism as in any business or occupation at home. 
Not only is every officer worth his salt eager to get 
the best and most competent non-commissioned offi- 
cers that he can find among his men, but there is also 
now a formal Army order in both the British and the 
French forces requiring each and every colonel to 
recommend every three months a certain minimum 
number of men and non-commissioned officers from 
the ranks of his regiment for promotion to a cadet- 
ship in the Officers' Training Corps. 



408 THE DOCTOR IN WAR 

A modern army in the field is a complete, perfectly 
organized, self-contained, bachelor community. Save 
for the fact that all its members are vowed to tem- 
porary celibacy, the whole length of the Western 
Front is like one continuous industrial village or 
model suburb, with all the mills running at full blast 
day and night. With all its hatef ulness and hardships 
trench warfare, instead of being a round of dull and 
dreary outpost duty, with monotonous killing of 
time in comfortless camps, is one constant, busy, 
enterprising push and struggle against the enemy, 
with all the methods and resources of modern science, 
as active, as bustling, as resourceful, and far more 
interesting and exciting, than even successful indus- 
trial business or professional life in peaceful times at 
home. 

There are as many different trades and occupa- 
tions running full blast in the war zone as there are 
in an urban community at home, and all of them plied 
by soldiers. The War Department recently adver- 
tised for men urgently wanted for the needs of the 
Army, skilled in sixty-six different trades! "Tinker, 
tailor, soldier, sailor, rich man, poor man, beggar 
\ man, thief, doctor, lawyer, Indian chief," with the 
delightful and refreshing exception that there is 
neither "poor man, beggar man, nor thief" in the 
war democracy. The only articles of property which 
Tommy or Alphonse seems to be in the least afraid 



THE UNIVERSITY OF THE ARMY 409 

of losing in camp are dogs, war relics, and pipes, 
which are regarded as "wild game," like umbrellas 
and watermelons at home. 

"Tinkers" are legion both in numbers and kinds, 
for the wearing-out and breaking-down of every kind 
of a plant and equipment in war is from five to ten 
times as rapid as in peace, and a man who has a craft 
or a natural gift in any and every imaginable variety 
of the repairing and reconstructing line, from the 
cobbling of shoes and mending of belts up to the 
straightening of rifle-barrels and the curing of engine 
troubles in autos, or of the intestines of howitzers, or 
the rejuvenation of " driven-down " airplanes, can 
find abundant and constant occupation. The life of 
a magazine rifle, for instance, in actual service is said 
to average about two to three months; that of a 
motor on war duty about six weeks. 

The whole purpose of the steady cataract and 
avalanche of enemy shells poured upon our lines 
every day of the week and every week of the 
month, is to fill up and obliterate trenches faster 
than they can be dug out again. Hence everybody 
in the trenches works, constantly thickening bomb- 
proofs and dug-outs, strengthening their roofs, 
and burrowing more deeply underground, to keep 
himself shell-proof; the moment you quit you're 
"snowed under." 
(/ The so-called fixity and rigidity of trench warfare 



410 THE DOCTOR IN WAR 

is in one sense only apparent. Armies to-day have to 
work harder to stay in one place than armies of the 
open warfare of yesterday had tc*advance a hundred 
miles. The mere repair and upkeep of the trenches 
for the firing-line and of dug-outs, bomb-proofs, and 
underground galleries for the troops in support be- 
hind the third trench, will occupy a third of the total 
man-power of the army. A trench is literally moulded 
upon and supported by the bodies of men, and is 
perpetually changing and growing like a live thing. 
It has to fit the bodies of the men who occupy it like 
the cell of the honeycomb does the working bee. 
Roughly speaking, it can be only six inches deeper 
than the height of the tallest man in it, and about six 
inches wider than double the depth of his body from 
chest to back. Most first-line trenches are dug just 
wide enough for the men to be able to glide past one 
another by turning sideways. 

They must fit the holding troops like a suit of 
clothes. If they are too shallow, obviously the heads 
of the men will be exposed to the horizontal flying 
fragments of shells which strike on the surface in 
front or behind them. If they are more than a foot 
above the heads of the men, there is danger, when a 
big shell crushes in the front wall, of burying them so 
deeply that they will be unable to dig their own way 
out. Their extraordinary and inconvenient narrow- 
ness is due to the stern mathematical fact that, 



THE UNIVERSITY OF THE ARMY 411 

whereas the only shells that can inflict serious and 
extensive damage on the men are those which fall 
directly in the trench, obviously a trench which is 
three feet wide is just twice as dangerous as one 
which is only eighteen inches, and greater widths in 
proportion. 

Front trenches cannot be lined or strengthened to 
any considerable extent with stone or iron plates, or 
even wood or cement, for the reason that while men 
can work their way out or be dug out from under a 
foot or even two feet of loose earth before they are 
smothered, it is a much more serious and dangerous 
matter if the cave-in carries with it beams, or stones 
or iron plates to trap and crush bodies and limbs; 
while in the case of stone and wood the splinters 
which will be sent flying by a shell-burst may be 
almost as dangerous as the fragments of the shell 
itself. 

If the men are left entirely to themselves, they 
have a natural and pardonable tendency to burrow 
steadily deeper on " Safety First" principles, al- 
though this again is considerably checked by the like- 
lihood of striking ground-water in most soils when 
you get below a moderate depth. The champion per- 
formance in this line which I saw was that of a canny 
and elderly French regiment, which had held trenches 
in a firm, well-drained soil for many months, and 
had gradually, almost unconsciously, lowered them 



412 THE DOCTOR IN WAR 

to the luxurious depth of eleven feet so that they had 
to use ladders to get up on to the fire-step! But this 
was an eccentricity, and the bitter experience of 
years of actual warfare has clearly shown that deep 
trenches, in spite of their comfort and sense of se- 
curity, like too deep and elaborate dug-outs and 
underground chambers, have proved more danger- 
ous as traps for the burying and suffocating of whole 
bodies of troops or for their capture as prisoners 
than helpful in protecting against shell-fire. 

In short, human bodies holding and moving about 
in shallow runways in the soft surface of Mother 
Earth have proved the only real fortifications in 
modern war, the only barrier which can defy the 
terrors and check the advance of the hugest guns 
and the highest explosives. 

So that the term spent in the front-line trenches 
is not just simply a period of vigilance, hardship; 
and passive exposure to danger, but one of almost in- 
cessant repair and construction and extension. No 
trench left to itself would last forty-eight hours under 
modern shell-fire. The same is true even in a higher 
degree of the much longer period spent in reserve and 
rest camps behind the lines. On account of the extra- 
ordinary range of modern big guns and of the tre- 
mendous part played by bomb-dropping airplanes, 
the destruction which is being incessantly wrought 
far behind the lines upon camps, barracks, shelters, 



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THE UNIVERSITY OF THE ARMY 413 

and villages, railheads, hospitals, roads, and light 
railways by enemy fire is second only to that in the 
front-line trenches themselves. This, added to the 
natural effects of the elements, makes incessant re- 
pair and reconstruction the standing orders of the 
day. And to suppose that time hangs heavy upon 
the hands of the soldiers, even in reserve and rest 
camps, would be a great mistake. 

On the contrary, so active have become the de- 
mands of enthusiastic officers, with a keen eye for 
repairs and improvements, especially since road- 
building and agriculture have been added to the 
regular military duties of an army, that the soul of 
Mr. Thomas Atkins has been seriously and resent- 
fully disturbed. He left his happy home and came 
out to France to fight, not to plough fields and dig 
ditches and build roads and bridges and model 
barracks. 

I was actually told, on one section of the Front 
in Flanders that I visited, that the men had sent a 
delegation to the general commanding asking to be 
allowed to spend more time in the front trenches and 
less in rest and reserve camps, where these irksome 
and degrading fatigue duties were demanded of them 
from morning to night! This is interesting both as 
showing what an active, busy life the modern sol- 
dier's has become, and second, how lightly the sea- 
soned soldier holds the horrors of modern shell-fire 



414 THE DOCTOR IN WAR 

and the rack and agony of that terrible modern war 
strain which we hear so much talk about. 

Scarcely an aptitude or capacity of the human life 
can be imagined which cannot be given full play and 
scope in the industrial democracy of modern war. 
Indeed, it would hardly be too much to say that the 
man who is just plain fighting man and nothing 
else is the exception and not the rule. Not only is 
there this wide range of opportunity for development 
from the general and the doctor and the judge down 
to the cobbler, the tailor, and the cook, but each one 
of these has its open and recognized line of promotion 
and advancement to almost any degree of author- 
ity and usefulness. The leading positions in, say, 
the commissariat department, in the army service 
corps, in the quartermaster's service, in the con- 
struction and engineering department, are as influ- 
ential and honorable and as well paid as almost 
anything in the pure line itself. 

To become a member of a great community of serv- 
ice, sinking individual and selfish interests in devotion 
to a common end, is in itself a wonderfully broaden- 
ing experience and a liberal education. Although 
organized for destructive instead of constructive pur- 
poses, the atmosphere that one becomes keenly con- 
scious of in the great military democracy of the 
Front is one almost Utopian in its justice, its fairness, 
and its eagerness for mutual helpfulness and service. 



XXIII 

THE ARMIES AT PLAY 

LAUGHTER is to the spirit what sunshine is to 
the air; neither can keep sweet without it. And 
the soldier must laugh even oftener than the civilian, 
because his life is harder and more dangerous. He 
has so much of the bracing, stinging frost of danger 
and of the dreary, chilly rain and sleet of hardship, 
that he must have frequent periods of the sunshine 
of laughter and enjoyment, or stiffen and sour under 
the strain. 

The thing that brings home most forcibly to the 
visitor at the Front that a modern army camp is a 
full-blown, self-supporting community, a real city 
under canvas, or town under tar-paper, is neither its 
size, which is often that of a State capital, nor its 
steam laundry, its huge dining-halls, its wooden side- 
walks, its general store, its tobacco and candy shops, 
its soda-water fountains, its bank and express office. 
It is the fact that its largest building is a moving-pic- 
ture theater and concert-hall, its most attractive out- 
of-door space, the primitive little platform or " play- 
ers' pitch," with booth-like dressing-rooms set at the 
foot of a circling rise of the ground, or in the hollow be- 
tween two hills, so as to face a natural amphitheater, 



4 i6 THE DOCTOR IN WAR 

where plays and open-air spectacles, or lectures and 
patriotic addresses can be given to three or four 
thousand soldiers at once. 

Next after these come the football field, and in an 
American camp the baseball ground and stand — 
though "grand " it could hardly be called. Then, as 
one watches the streams of bright-eyed, vigorous 
humanity which pour through the streets of the 
army town after the bugles have blown in the after- 
noon for rest and play and follows the principal cur- 
rent, one quickly comes to that matchless soldiers' 
club and refuge of homesick hours, the Y.M.CA. 
Hut. This "hut " is a rough but comfortable wooden 
hall from forty to eighty feet long, where concerts 
and lectures and " chalk- talks " and " sing-songs' ' 
and "smokers" are the continual order of the day, 
or rather of the night. Classes in French and his- 
tory and literature and chemistry and other sci- 
ences are provided for the educationally disposed, 
and manly, kindly, practical talks on applied Chris- 
tianity, with the dear old familiar hymns. The offi- 
cers of the regiment, the Colonel, the Quartermaster, 
the Doctor, come in and talk with the young soldiers 
in an unofficial capacity, so to speak, giving them 
fatherly advice and information on the standards, 
the high traditions, the duties and the temptations, 
the glory and the rewards, of a soldier's life. 

How popular and well appreciated they are may 



THE ARMIES AT PLAY 417 

be glimpsed from the fact that the only complaint 
which one eager young secretary made to me was the 
smiling one that the hall was n't big enough to hold 
half the crowd that wanted to get in to the talks and 
concerts, and that the "overflow" would insist on 
crowding every window so full of heads as almost to 
cut off the supply of air for those inside. 

Between entertainments the hall is filled with little 
tables for writing home, reading, and playing games, 
a good supply of newspapers, magazines, and recent 
books being kept on hand. Nor are creature comforts 
by any means neglected: each hut has an excellent 
canteen and lunch-counter, where soft drinks, hot 
coffee, pie, eggs, sweet-stuffs, and other home-like 
delicacies, not included in the Army ration, are sup- 
plied all through the afternoon and evening. The 
prices are very moderate and any profit which may 
be made is applied to the upkeep of the hut. 

In our American camps these Y.M.C.A. Huts are 
supplemented by regimental canteens with reading- 
and writing-rooms, and in the English camps there 
are either Church Army Huts or Salvation Army 
Huts, with similar equipment and programmes, only 
with not so many concerts and lectures and educa- 
tional features. All these organizations are doing 
most valuable and devoted work, and it need hardly 
be said that those of religious character and spirit, 
while stanchly true to their ideals, are magnificently 



4 i8 THE DOCTOR IN WAR 

"long" on human helpfulness, home-like sociability 
and comfort, wholesome amusement and intelligent 
recreation, and mercifully short on formal theology 
and nice dividings of doctrine. 

The only approach to any display of doctrinal 
prejudice was the resentful and spontaneous out- 
burst on the part of a peppery old General when re- 
quested to provide quarters for the Salvation Army: 
to the effect that he 'd be hanged if he 'd submit to the 
idea getting abroad that the soldiers of his division 
were bad enough to need converting by hallelujah 
methods! This, of course, is a matter of individual 
opinion, but after one has actually seen a few hun- 
dred thousand fighting men of this war on the 
Front and found what manly, kindly, self -controlled, 
splendid fellows they are, one begins to feel a dis- 
tinct sympathy with the good General's resentment. 

And when the Salvation Army actually got into 
the war it proceeded to play pies, doughnuts, and hot 
coffee under fire as its "long suit," with kindliest 
fatherly advice and assistance and motherly care 
and services instead of cymbals and hallelujahs. 
Few agencies have got closer to the hearts of our 
boys in France than the Salvation Army. 

It would be hard to speak too highly of the splendid 
services rendered by the Y.M.CA. on both the Eng- 
lish and American Fronts. What the military author- 
ities and the Government themselves think of it may 



THE ARMIES AT PLAY 419 

be seen from the fact that one of its chief secretaries 
in London, Sir Arthur Yapp, was knighted over a 
year ago and has since been asked to assume, in addi- 
tion to the secretarial and Army Camp duties, the 
leadership of the great food economy campaign, so 
that he has become one of the most prominent and 
influential men in England. 

The courses of lectures and concerts and other 
entertainments are by no means limited to local tal- 
ent or chance volunteers. On the contrary, a regular 
entertainment bureau has been organized, which 
secures not only lecturers and entertainers from all 
over the United Kingdom, but also prominent min- 
isters, lawyers, doctors, and scientists, who are sent 
out on regular tours of speaking and lecturing all 
along the Front and through the Training-Camps at 
home. Some of the ablest speakers and writers vol- 
unteer gladly for this service, and it is hardly too 
much to say that the average soldier, unless he has 
come from a great metropolitan center, has a finer 
or better opportunity to see and hear the best and 
most worth-while of both men and ideas than he 
could have had in his own home neighborhood. 

But, as if even this were not enough, about the 
second year of the war there came a demand from 
the men themselves for even more serious and sys- 
tematic information and instruction. I was greatly 
interested to find last spring that the English Govern- 



4 20 THE DOCTOR IN WAR 

ment was sending out to the camps at the Front some 
of its greatest teachers and leading authorities in all 
sorts of fields, such, for instance, as naval affairs, the 
problem of modern aeronautics, international law, 
modern history, chemistry, French and English liter- 
ature, and arranging for them to give short courses 
of lectures in their special subjects, followed for those 
who wished it by a sort of University Extension 
examinations. Just to mention a few of the best-, 
known names: Mr. H. G. Wells, Professor Arthur 
Pollen, the naval expert, Professor Gilbert Murray, 
Dr. Frederic W. Mott, the famous pathologist, and 
Sir Frederick Treves, one of the surgeons to the Royal 
Family, and other men of like caliber. 

On the athletic side of its play an English or 
American Army Camp is like a well-organized college 
or high school. In the first place, while the great 
movements of the armies are on the mpst massive 
and formal scale, there is a surprising amount of 
scope left for individual initiative and ingenuity of 
junior officers, sergeants, and even the men them- 
selves, in planning and carrying out those innumer- 
able little private entertainments and local vendettas 
known as raids, patrolling movements, and " feelers.' ' 

The tactics of these little fracases are as elaborate, 
as involved, and as mysterious as the strategy and 
signals of a football team. Every detail is worked 
out and rehearsed for days and even weeks in ad- 



THE ARMIES AT PLAY 421 

vance, and the ingenuity and enthusiasm expended 
in planning something new "to put over on Fritz" 
is something incredible, and about as stimulating 
intellectually as anything that can well be imagined. 
Every last private must not only understand per- 
fectly the whole scheme and be letter perfect in his 
own part, but often be ready with two and some- 
times three alternative courses of action in the event 
of any part of the scheme miscarrying. No Man's 
Land after dark is no place for a "bonehead." 

Never before in war was so high a premium placed 
upon individual intelligence and initiative, and on 
direct observation one begins to discover some little 
basis for the consoling belief that, in spite of the whole- 
sale destructiveness of modern warfare, intelligence 
does distinctly increase the chances of survival. 

On the lighter side of athletic life every regiment 
has its football team, its tug-of-war team, its cham- 
pion sprinter or hurdler, or putter of the shot, and 
meets and field days of all sorts, including even box- 
ing tournaments, are held as regularly, and far more 
enthusiastically, than regimental inspections. 

All sorts of unexpected faculties and habits come 
in useful in war-time. The most distinctive feature, 
to a Northerner, of a Latin town or village, whether 
Mexican, Cuban, French, Spanish, or Italian, is that 
it possesses a plaza and has the boulevard habit. 
Both of these institutions are ostensibly intended for 



422 THE DOCTOR IN WAR 

special functions of their own, the plaza being a for- 
mal, central square or park for the grouping and 
enhancement of public buildings and official resi- 
dences, while the table-covered terraces of the boule- 
vard are a mere overflow from the cafes which 
border it. 

But the real function and excuse for existence of 
both of them is their frank recognition of the eternal 
truth that the darling 'Study of mankind is man, and 
the superb facilities which they furnish to the entire 
community, from the lowest to the highest, to enjoy 
freely this keenest and most lasting of pleasures : to 
see and to be seen, to talk and to listen, to feel one's 
self warmly and actively in touch with all the cur- 
rents and interests of one's kind; in short to be "in 
the swim," "on the spot," as our English cousins 
say, "in the know." Here one can stroll and be 
looked at or sit and pass judgment, can hear the 
freshest gossip, pick up the most confidential of 
news, and retail the spiciest of scandals. 

So important, in fact, do most Latin communities 
hold this side of life that they deliberately devote, 
not merely all the languorous summer evenings, but 
from two to three hours in the middle of the winter 
day in the cafes to this form of intellectual exercise 
and development. And a man's standing in the com- 
munity, even in so busy and bustling a city as Paris, 
is often determined almost as much by his social 



THE ARMIES AT PLAY 423 

gifts, or powers of eloquence and reasoning in these 
open forums as by his financial standing or his po- 
litical or professional abilities. 

This habit and tendency form a wonderful asset 
and advantage when it comes to providing entertain- 
ment and recreation for an army in the field. In the 
French Army Camps the formal entertainments and 
educational features are taken care of by the "Foyer 
des Soldats," or " Soldiers' Hearth," a very cheerful 
and useful men's club, but with a less extensive and 
complete organization than the Y.M.C.A. or the 
Official English Lecture Courses, for the greater 
part of the men's recreation is spontaneous and un- 
official. Every one who lives long among the French 
people is struck by the fact that they have a much 
greater capacity for entertaining themselves than 
have we more chilly and self-contained Northern 
races. They are less self-conscious, are far better con- 
versationalists, and have much easier and more natu- 
ral graces and manners. So that the mere society of 
their kind is to them a perpetual feast, and a package 
of hayseed tobacco, with a couple of "mazagrans" 
or glasses of light wine, and a dozen or fifteen of their 
comrades and cronies, will provide never-failing enter- 
tainment and delight three hundred and sixty-five 
nights out of the year. 

The conversation in many of these camp-fire groups 
and dug-out debating societies is excellent, some of 



424 THE DOCTOR IN WAR 

the most entertaining and informing that I have ever 
listened to, even under the handicap of an imperfect 
apprehension of all the subtleties of the eloquent but 
elusive French tongue. Every grade of intelligence, 
every type of interest, every social viewpoint is 
represented in the rank and file of the French Army. 
The shaggy poilu, in faded blue tunic and ploughboy 
boots, who sits on the cracker box opposite, may be 
a famous artist with scores of successes in the Salon 
to his credit. The trim young Sergeant, proud of his 
honor stripes, who sits next to you, may be a rising 
poet and darling of the cafes of the Quartier Latin ; 
while the burly, grizzled Major on your left may be 
a lecturer at the Sorbonne or an eminent authority 
on international law. 

Nor is this a mere fancy sketch. In one single 
headquarters mess in a little country inn in the 
Vosges, whose guest I was, one academic or scientific 
title after another was mentioned, until I asked per- 
mission to make formal count, and we found around 
the plain pine table no less than five college pro- 
fessors, one Academician, a former Deputy of the 
French Parliament, and a well-known essayist and 
critic. And on my visits to the French Front I found 
myself looking forward eagerly all day to the eve- 
nings spent over the coffee-cups and the decanters 
with the officers, whose ready wit and glancing hu- 
mor, whose eloquence and gay delight in defending 



THE ARMIES AT PLAY 425 

the most daring and startling of paradoxes, whose 
keen logic and brilliant criticism form some of the 
happiest memories of my entire trip. 

Even the rank and file of the French Army are for 
the most part surprisingly well read and well informed 
on most of the subjects of the day — except any his- 
tory, or geography other than that of la belle France, 
everything outside of whose thrice happy borders 
is a wilderness and desolation to them. And they 
can weave the most beautiful and animated and 
eloquent evening's conversation out of the ideas 
suggested by a mere handful of insignificant facts, 
which would scarce have provided material for a 
dozen responsive grunts between phlegmatic and 
unimaginative Anglo-Saxons. 

The French camps have excellent official theaters 
and moving-picture shows, and whole companies of 
famous actors and actresses and vaudeville stars vol- 
unteer their services to travel up and down the lines 
and bring pleasure and relaxation into the lives of 
those who have devoted themselves to the defense 
of their country. 

Similar organizations and arrangements exist along 
both the English and the Italian Fronts, and one of 
my most picturesque memories is an open-air the- 
atrical performance that I attended in a beautiful 
little bowl among the hills, just at the foot of the 
Carso, where a company of actresses and actors from 



426 THE DOCTOR IN WAR 

Milan presented with spirit and vigor two charming 
little comedies before almost half a division of Italian 
soldiers, over four thousand strong. The huge de- 
lighted audience of Bersaglieri in their sweeping 
cocks' -plumes, of infantry and artillerymen in their 
shimmering gray, and of Alpini in their green Tyro- 
lese hats and deers' tails, was most appreciative, but 
keenly critical as well. One music-hall favorite had 
omitted one of the sauciest verses of her song out of 
deference to the dignity of the Generals of the Head- 
quarters' Staff who filled up the front rows with their 
stars and ribbons. The soldiers noticed the omission 
at once, and when she came back for her encore they 
shouted loudly, "Sing the other verse, signorita! 
Never mind the Generals; they won't care, and the 
Censor is n't here! " 

The only other disturbance of good order was when 
an impudent Austrian airplane came zooming over 
the Carso and tried to get near enough to break up 
the show with bombs instead of cabbages and eggs. 
But a couple of Italian machines promptly shot up 
and chased him away before he could get near enough 
to do any damage. 

The reading-room, letter-writing, and light restau- 
rant accommodations for the Italian soldiers are 
provided by the wooden halls known as "Casa dei 
Soldati." These are equipped and generously sup- 
ported by the larger Italian cities — Milan, Turin, 



THE ARMIES AT PLAY 427 

Bologna, Florence — and are gratefully appreciated 
by the soldiers. But when it comes to entertainment 
and amusement, the Italian soldier can take care of 
himself even better than his French comrade. He is a 
wonderfully cheerful, happy, plucky, uncomplaining 
chap, the best of good company to himself and to 
every one else about him. I don't mind confessing 
that I fell completely in love with him in my month 
on the Isonzo and formed a very high opinion of his 
intelligence, endurance, and soldierly qualities; which 
I am proud to feel has been more than justified, after 
his temporary disaster on the Isonzo, by his splen- 
did tenacity and determination on the Piave, the 
Brenta, and Monte Grappa. 

He is content with the simplest and plainest of 
foods — bread, cheese, meat stew, onions, red wine — 
hard work all day and a hard couch at night, if he 
can only have a couple of hours in the sunset and 
the twilight to stretch himself and chat and joke, 
to strum upon his mandolin, to sing to its plaintive 
strains or dance to its lively ones. His pluck and 
cheerfulness, when wounded and suffering, are simply 
beyond praise. I have heard men shot through the 
chest or abdomen, or with both legs shattered, joke 
and laugh with the bearers, as they were being lifted 
out of the ambulance to be carried to the operating- 
table. 

No army on the Western Front could show finer 



428 THE DOCTOR IN WAR 

examples of heroism and devotion. I saw the slopes 
on the Carso where, in the early months of the war, 
when they were almost destitute of heavy artillery, 
one volunteer party after another had rushed right 
up to the barbed-wire entanglements of the Austrian 
intrenchments, carrying tubes of high explosives 
which they hurled into the wire by hand — well know- 
ing that none would return un wounded, and few 
alive — until a breach was cleared through which 
the columns behind could pour over their bodies and 
flood the enemy trenches. 

No other army had so splendid a record and dis- 
play of patient, tireless work actually accomplished, 
of superb automobile roads, carried to the very tops 
of the mountains, of bridges built, tunnels bored ; of 
mountains pierced or their whole tops blown off by 
mines; to say nothing of heavy guns dragged up 
above the snow-line or mounted on giddy peaks 
where there was scarce footing for a chamois, and 
wonderful cable aerial railways swinging like spiders' 
webs from crag to crag or from the brink of the preci- 
pice to the valley below. 

Really they were such a busy and industrious com- 
munity that they struck me as having less leisure for 
mere entertainment and educational activities than 
almost any army that I visited. After a hard day's 
work to smoke and chat and lounge in the soft eve- 
ning air seemed to be enjoyment enough for them; 



THE ARMIES AT PLAY 429 

while the officers were such courteous and obliging 
guides, such stanch and cordial comrades, such 
charming good company and good fellows that my 
eye lights up and my heart warms to this day at 
the very sight of an Italian uniform. 

In all the French, and in many of the Italian, camps 
there were excellent cooperative stores, managed by 
committees appointed by the men themselves, which 
supplied tobacco, chocolate and other sweets, soap 
Jand toilet articles, stationery, smaller articles of 
wearing apparel, and the innumerable odds and ends 
required to supplement army supplies in a camp. 
Buying at wholesale and often in conjunction with 
the army contractor, these stores were able to supply 
an excellent quality of goods at very moderate prices. 
Just as an illustration, on several different occasions 
the officer who was acting as my guide and escort 
would make some excuse for going past the coopera- 
tive store, because he could buy some particular 
brand of cigarette or toilet article or pocket cutlery 
cheaper than he could in the regular shops in the 
towns at the Base or even in Paris. All profits made 
were returned to the soldiers. 



XXIV 

THE PULSE AND TEMPERATURE OF 
FRANCE 

IT is as hard to fix any single test and index of the 
health and resisting power of a nation at war as 
of an individual. The numbers of a nation may be 
counted, the weight of a man taken on the scales, 
but this gives mere bulk, not quality. Whether the 
bulk be fat or muscle, chest or "corporation," "bay 
window," remains to be seen. 

One can measure the bulge, or the lifting power, or 
the punch of the muscles of an athlete, or list the size 
and equipment of the army which a nation can call 
to its colors. But these are the mere cutting edge of 
the ploughshare ; how it will drive its conquering way 
through the long stern furrow of war or fever depends 
upon the heart and circulation and vital resources 
behind it. 

A nation at war is like a man fighting a fever, or, 
more aptly, like one who has had the valves of his 
heart damaged, so that its muscle has to work much 
harder to pump the same amount of blood over the 
body. At first everything is excitement and upset 
and block, half the normal activities thrown out of 
gear. Collapse seems imminent, but gradually a sort 



THE PULSE OF FRANCE 431 

of compromise is adjusted, some parts of the body 
learn to do with less blood, others to utilize more of 
it; "compensation," as we say in pompous techni- 
cal terms, "is established,' ' and a working balance 
reached which may be maintained for years and even 
decades. 

Some cynic physician philosopher has declared that 
the best way to reach a good old age is to acquire 
some chronic disease and then take good care of it. 

Nations have even greater, wider powers of "com- 
pensation " and adjustment than individuals because 
their vital organs and "parts" are interchangeable, 
and they never die. Moreover, paradoxic and even 
incredible as it may sound, there is ground for doubt 
whether war is as utterly abnormal a state for a 
nation as fever is for an individual. Certainly it is a 
process of which it has had an astonishing amount of 
experience, and which, if it had not been well able to 
"carry on," for long periods without vital damage, it 
would never have survived to the present day. 

Indeed, though we speak most confidently and axi- 
omatically of peace being the usual state and regular 
business of a nation, while war is its occasional and 
exceptional addiction and interlude, yet even this 
belief is not so firmly based as could be wished. For 
instance, careful study from this point of view of the 
last four hundred and fifty years of European history, 
from 1450 to 1900, by Dr. Frederic Adams Woods, 



432 THE DOCTOR IN WAR 

reveals the appalling fact that in the first century of 
that period war occupied fifty-five per cent of the 
time and in the last century over thirty per cent /In 
the whole four hundred and fifty years there have 
been only two periods, one of ten and the other of 
seventeen years, of complete and universal peace all 
over the Continent. So that while Europe has un- 
questionably made its greatest and most wonderful 
progress during the last century of comparative peace, 
it evidently takes a good deal of war to crush or 
"bleed white" a nation. 

No more vivid and wonderful demonstration of the 
rallying powers of a nation under the strains and 
horrors of war has ever been furnished than that of 
heroic France to-day. For four years she has been 
the chief bulwark of democracy and free civilization 
against the invading flood of a new scientific savagery 
and feudalism, and yet her head is up, her eyes are 
bright, her fire undimmed and indomitable. 

The visitor to France to-day, instead of being 
struck by the evidences of change and exhaustion or 
decline of bustle and activity, is surprised to find so 
little surface change in her streets, her markets, and 
her great centers of traffic. If it were not for the 
strong tinge of "horizon blue" in the busy crowds, 
the pitiful prevalence of black in the costumes of the 
women, and the dim lighting of the streets at night, 
one would have to shake one's self and recall the 



THE PULSE OF FRANCE 433 

historic facts to realize that one is really in a country 
which is desperately at war. 

Part of this is due to the heroic endurance and lofty 
pride of the French nation, particularly of the women. 
But part to certain new and curious changes in the 
character of modern war, which even help to compen- 
sate somewhat for its abominations in other respects. 

One of these is the strange fixity or " ossification' ' 
of the fighting-line, due to the trench system of war- 
fare, so that railroad trains run right up to and into 
the zone of fire, almost up to the third-line trench 
every few miles, comparatively speaking, all along 
the Front. This makes "the war" quite accessible 
and convenient, so that soldiers from all over the 
southern and eastern parts of France can reach their 
billets on the Front within a day's ride or even a few 
hours from home, and can come back again on peri- 
ods of leave or permission every three to six months. 

This may look like a trivial thing in itself, but 
psychologically it helps greatly to reassure and to 
take off some of the worst edge of the dread and 
anxiety of wives and families. Instead of feeling, as 
in former wars, that their sons and husbands are 
going away hundreds of miles, almost under sentence 
of death, with no prospect of ever seeing them again 
until the war is over or they are sent back disabled 
for life, the families of the soldiers can at least buoy 
themselves up with the hope of seeing them back 



434 THE DOCTOR IN WAR 

again on permission safe and sound within three 
months. 

And as with all the deadliness and fierce engines 
of destruction of modern war not more than five per 
cent of the combatants are either killed or seriously 
wounded or disabled by disease within a year, this 
hope of safe return is fulfilled in the vast majority of 
cases a number of times before they are even suf- 
ficiently severely wounded to be invalided home. 
This much more frequent opportunity of visits home 
from dear ones in the trenches, while, alas, it can 
do little to lighten the terrible blow when it does 
fall upon the five per cent, does much to relieve the 
tension of agonized dread and brooding anxiety of 
year-long periods of absence in the ninety-five per 
cent where no disaster occurs. 

At all events, it does visibly and mercifully take 
off some of the agonized tension of grief and forebod- 
ing dread from the departure of a troop train, or of 
the farewell of a soldier to his family at the gates of a 
great railway station. He has come back before safe 
and well, why not again? 

Incidentally, also, this constant and comparatively 
frequent interchange and communication between 
the Front and the home town helps to keep the 
appearance of the streets, particularly of the larger 
towns and main railroad centers, unexpectedly nat- 
ural, by taking off the sense of a scarcity of young 



THE PULSE OF FRANCE 435 

men in the crowd. Indeed, this, in addition to the 
fact that only a certain percentage of the troops is 
actually at or near the Front, the remainder being 
held in reserve in training-camps scattered all through 
the country, and incessantly transferred backward 
and forward from active to reserve duty, makes an 
almost constant flow and thronging of men in uni- 
form through all but the smaller towns and country 
villages, and even in a great many of them. So that 
there is much more going on in the way of travel, 
trade, business, and even amusement and society of 
a sort, over all the central and eastern half of France 
than one would have expected from conditions in 
previous wars. 

A second peculiarity of modern war, which has 
helped France to adjust herself and maintain a work- 
ing balance even under the terrible strain which she 
has suffered, is that it is so emphatically and over- 
whelmingly a war of machinery and big guns. Its 
motto is a paraphrase of Napoleon's "Audacity,'' 
"Ammunition, and again ammunition, and always 
ammunition !" or "Shells to save life," in Lloyd 
George's paradoxic phrase! For the army that has 
most guns and ammunition loses fewest soldiers in 
an offensive. 

A war of munitions and railroads, of telephone and 
telegraph and electrical equipment of every imagin- 
able sort, of huge howitzers mounted like observatory 



436 THE DOCTOR IN WAR 

telescopes, moved by clockwork and aimed with sur- 
veyor's transit, of airplanes and motor lorries and 
motor ambulances by the hundred thousand. This 
enormous and incessant demand has stimulated man- 
ufacturing and production of all sorts so tremen- 
dously, new factories springing up like mushrooms 
everywhere to meet it, that the whole civilian popu- 
lation at home, the women and children of the sol- 
diers, and the men too old or physically unfit for 
military service, instead of being thrown out of work 
and left to starve, have had abundant employment 
at double and even treble the wages they had ever 
dreamed of before. 

So great has been the rise in .wages, so keen the 
demand for labor, that many a soldier's wife or 
daughter is actually making more money at home in 
the war factory than the head of the family was able 
to earn in time of peace. Wages of all sorts on an 
average have doubled, and in not a few fields of in- 
dustry trebled, since the outbreak of the war. And 
it is one of the axioms of military experts that a na- 
tion is physically able to put no more than one tenth 
of its total population in the field for active service, 
or one half of its men of military age which means 
about one third of all males of working ages. This 
means that most of the other two thirds and all the 
women of the community have been earning higher 
wages than they ever did in their lives before. 



THE PULSE OF FRANCE 437 

Wages have actually kept pace with the higher 
cost of food, and as many families have now two and 
three wage-earners in the place of one, the net result 
has been, in the almost unanimous opinion of those 
interested and expert in labor conditions in France, 
that the great mass of her people are better fed, bet- 
ter clothed, and are working shorter hours and under 
more healthful conditions than they were before the 
war. 

And this was the distinct impression, for whatever 
it may be worth, which I gained from my own per- 
sonal observation. I spent nearly six months in 
France last year, from spring till late autumn of 
19 1 7, making numerous journeys both to and from 
the Front and through the interior, covering some 
thirty or forty different regions and towns, from 
country districts up to great cities, and found sur- 
prisingly little sign of unemployment, of destitution, 
or of visible underfeeding or food scarcity. 

I was particularly careful to visit the industrial 
sections of the cities and towns, the slums if any, and 
the poorer and outlying streets of the country towns 
and villages, to watch the crowds at the factory gates, 
on the streets, in the parks in the evenings and on 
holidays, and especially to keep a keen eye upon 
that best and most graphic index of the vital condi- 
tion of a community, the faces of the children. 

Much to my relief and gratification, after the pessi- 



438 THE DOCTOR IN WAR 

mistic and discouraging reports which I had heard 
before I visited France, I found the overwhelming 
majority of the quaintly charming and intelligent 
little future citizens of the Republic playing hard and 
happily, with bright eyes, fresh color, and sturdy, 
bare, brown legs. They scurried eagerly about, shout- 
ing at the tops of their voices, and making wonderful 
gesture-play as merrily as if they had n't a care in 
the world, and were as well nourished and vigorous, 
as free from visible defect or disease, as the groups 
which can be seen on our own streets. 

I was told by my colleagues, both French and 
American, who were engaged in work among the 
children and in children's hospitals, that the high 
value placed by the war on children and child life, 
had so stimulated the activities of the many public- 
spirited organizations for child welfare, both French 
and Allied, such as the English Red Cross and 
many other equally devoted but smaller organiza- 
tions, that the actual infant mortality-rate or death- 
rate among children under one year of age, instead of 
increasing, had been brought down in France to one 
of the lowest levels in her history! 

Incidentally, a like unexpected and gratifying re- 
sult has been brought about in many districts in 
Belgium by the devoted efforts of Belgian philan- 
thropists and physicians backed by our American 
Belgian Relief Commission. And, of course, Germany, 



THE PULSE OF FRANCE 439 

who did not put one little finger to the work, is char- 
acteristically claiming the entire result as one of the 
visible blessings of Prussian rule and the sway of 
Kultur. 

To put it roughly, a considerable share of the huge 
sum voted by the French Government for war ex- 
penses has gone directly back into the pockets and 
the lives of the working-class majority of her popula- 
tion in the form of high wages, and while this will 
have to be paid for some day, yet for the present it 
greatly helps to redress the balance of industry and 
economic prosperity so rudely shaken by war. 

Part of it is an actual drain upon the total reserves 
of the country in the sense of a new draft upon the 
strength and vital resources of its women, who have 
so nobly and splendidly risen to and met the emer- 
gency. But not all of it, by any means, because the 
thing which has made it possible has been the intro- 
duction of the most modern labor-saving machinery 
on a tremendous scale, as well as modern efficiency 
methods of operation. 

The motor-power for this machinery is being 
largely and increasingly drawn from the hitherto 
unutilized natural water-power of the country. A 
most interesting and striking shift of the great manu- 
facturing industries of France has been made from 
the northeastern regions, where the coal is, down to 
the plains and valleys of the south and southeast, near 



440 THE DOCTOR IN WAR 

the mountains where the water-power is. Which also 
has the advantage of helping to offset the German 
occupation of some of the richest coal mines and of 
placing the industries and their swarms of workers 
at a safer distance from bomb-dropping raids and 
other hostile interference. France has not lost for a 
moment either her splendid courage or her wonderful 
economic shrewdness and foresight in this terrible 
war. This utilization of her water-power will be a 
permanent addition to her national assets after the 
war. And the same is true in even greater measure 
in the case of Italy. 

It is not too much to say that most of this superb 
contribution of war work by the women of France 
has been made by the aid of labor-saving machinery, 
under such greatly improved industrial working con- 
ditions, with shorter hours and higher wages, that 
it has been no greater drain upon their resources 
and their health than the household or small shop 
or farm occupations, which they followed before the 
war. Indeed, it has actually been found, in a num- 
ber of munitions works studied, in both France and 
England, that the women were able to feed them- 
selves so much better on high wages, to give them- 
selves so much more regular rest, and to afford health- 
ful recreation and amusements and broader interests 
of life, that their health, instead of deteriorating, 
has actually improved under the work. In most 



THE PULSE OF FRANCE 441 

Government-controlled plants they are carefully 
supervised and guided by women physicians and 
other welfare workers, so that they know how to 
protect themselves and to take care of their health 
better than ever before. 

As for the much-talked-of shortages of food and 
even "famines," these actually for the most part are 
confined to certain special articles of food, such as 
sugar, butter, milk, white flour, pork, etc. Many of 
these, even, are only temporary and local in nature, 
and there are substitutes to be had except in the case 
of sugar. Taking it by and large — again speaking 
from the perhaps limited point of view of my own 
experience — the only serious obstacle to procuring 
an adequate supply of nourishing food in most parts 
of France that I visited was the price. And even that 
barrier became less formidable as one went down into 
the smaller towns and country districts. 

There was no white bread, but plenty of brown 
war bread; in fact, less restriction was placed upon 
the use of bread in the restaurants and cafes, and so 
far as one could judge in private houses, than in 
England. There was barely enough sugar for the 
coffee, but plenty of fresh fruit and vegetables, and a 
limited but adequate supply of fresh meat and ham. 
Prices in Paris and the other great cities were high, 
but no higher on an average than in New York 
or Boston, and the main difficulty was skirmishing 



'442 THE DOCTOR IN WAR 

about perpetually and exercising one's ingenuity 
over the bills of fare to find substitutes that were 
u just as good," on the two meatless days in the week 
and the two on which desserts, puddings, cakes, etc., 
containing much sugar could not be served. 

To take the rough test of restaurant prices all 
through the summer and up to the last week in Octo- 
ber, 191 7, when I left France, one could get in the 
medium-sized and smaller towns and, what furnishes 
a good average sample, in the dining-cars on the rail- 
roads, a good satisfying meal — soup or macaroni, 
fish or entree, meat, potatoes, salad, cheese, and fruit, 
for from 65 cents to $1.00. Comfortable accommo- 
dations and excellent meals could be got in country- 
town hotels, especially in the South and West or 
toward the Swiss border for from $1.75 to $2.50 a 
day. In the villages and country districts there was 
a good supply of food, though somewhat coarse and 
monotonous according to our American standards. 
Although there had been a distinct falling-off in the 
size of the principal crops, yet the smaller crops 
were sold at much higher prices and the farmers 
felt comparatively prosperous. Besides, it must 
be frankly admitted that no peasant or farmer 
anywhere in any country is going to run himself 
dangerously short of the food which he has raised 
himself in order to supply city people. 

The wheat crop of France, for instance, has fallen 



THE PULSE OF FRANCE 443 

off more than a third in three years, but the wages of 
the great mass of working-people have been so good 
that so long as a reasonable supply from abroad was 
procurable, they have been able to feed themselves 
well. The only fear was lest this supply should be 
cut down by the urgent need of ships for transport- 
ing our American Army to France, but our splendid 
shipbuilding programmes have relieved that diffi- 
culty already. 



XXV 

MOUNTAINS AND MEDICINE: ITALY'S WAR 
ON DISEASE 

ROME was almost as famous for her aqueducts, 
her baths, and her sewers as for her legions and 
her laws. So when her descendants and representa- 
tives of to-day make war, they proceed, on ancestral 
grounds, to attack its sanitary and surgical problems 
as thoroughly, as patiently, and as effectively as they 
attack its engineering and its military ones. For the 
offensive of 191 7 toward Trieste, which I saw, they 
had in readiness within twenty miles of the Front 
not only hundreds of thousands of men, thousands 
of guns, and millions of shells, but six hundred hos- 
pitals with one hundred thousand beds, and doctors 
and nurses and ambulances by the thousand. 

The " theater of war " is no mere figure of speech in 
the Italian campaign, for the whole drama is set in a 
huge natural amphitheater walled in by the semi- 
circular sweep of mountains, with dusty blue mists 
for drop curtains, lifted from time to time to show 
battle-fields literally hung up in the air, draped upon 
the shoulders of the mountains for a world to see. 

On a clear day you can see the shells bursting 
on the ridge-crests around Monte Nero, silhouetted 



MOUNTAINS AND MEDICINE 445 

against the violet sky, twenty miles away. And the 
mountains dominate the whole movement. 

It is a war of mountains, for mountains, between 
mountains — I had almost said by mountains; for no 
sooner is one mountain captured than it is organized 
and armed into a fortress for an attack upon the next 
mountain facing it across the deep valley. Every- 
thing has to learn to climb and half-dig itself in, 
half-hang on by its toe-nails and eyelids on some 
narrow shelf on the mountain-side : not merely men 
and guns, horses, mules, Field-Hospitals, Dressing- 
Stations, motor-dynamos, but huge water-casks 
and boats, great whale boats and barges, to be used 
for the pontoon bridges across the fierce little river 
at the bottom of the gorge below the next mountain. 

I have seen long black bateaux, capable of holding 
forty men, hauled up the "safe and sane" side of the 
mountain, where there are fine roads, on huge motor 
lorries or tractors, to be lowered by cable down the 
1 ' unhealthy " side over rocks, cliffs, and trees — for 
roads don't grow well under shell-fire — in the dark- 
est and quietest hours of the night — if there are any 
for the star-shells and Verey lights. 

Most of the plagues of the soldier are his old familiar 
home diseases in more vicious form. Typhoid, pneu- 
monia, tuberculosis, dysentery, heart disease, kidney 
disease, these are the maladies which account for the 



446 THE DOCTOR IN WAR 

vast majority of deaths in camp and barrack, just as 
in peaceful civil life. 

But sometimes the fierce earthquake of war shakes 
and hurls us back to the primitive, in both morals 
and maladies, and raises unexpected ghosts of strange 
and half-forgotten ancient diseases to vex us again. 
Some, fortunately, are too dead to rise again in any 
earthquake resurrection, however rending — "Black 
Death," smallpox, the sweating sickness, these, we 
believe, can never raise their heads again in any 
civilized and sanitary community; though we boast 
with our fingers crossed, and our knuckles rapping 
on ligno-cellulose substance. 

But a few of the historic plagues are not buried so 
deeply nor so dead, and two of them have come to 
life again in this war, typhus and cholera, both from 
the regions of the Unwashed East; both brought in 
by Austrian prisoners, typhus into Serbia, cholera 
into Italy. 

The typhus epidemic ran like wildfire through the 
war-ravaged and half-famished Serbia, until it was 
tackled, and not merely checked but completely 
stamped out, by the splendid and masterly work of 
an Anglo-American Commission. 

Italy's cholera epidemic faced her suddenly in the 
first year of the war, in most menacing proportions. 
The disease came in gradually and insidiously in the 
form of scattered cholera-carriers among the first 



MOUNTAINS AND MEDICINE 447 

thousands of Austrian prisoners. There were no 
open cases, nothing, in fact, to arouse any suspicion 
whatever until these prisoner carriers had been scat- 
tered out through a number of prison camps and 
had infected the water-supply of some of the Italian 
troops. 

Then, with the approach of the hot weather, like 
a forest fire that had run underground, the disease 
burst out in full vigor, in a dozen different centers at 
once, and within a few weeks the sanitarians had 
seven or eight thousand cases on their hands. 

But not a moment was lost in attacking the out- 
break. The Sanita of the Italian Army fell upon it 
at once, horse, foot, and dragoons, in a most work- 
manlike JFashion. All known cases were isolated in 
^comfortable hospital camps, given the best of treat- 
ment and care, and their discharges rigidly sterilized 
so as to prevent any further spread of the disease 
from them. 

How intelligent and effective was the treatment 
given them may be judged by the fact that, while 
the ordinary death-rate from cholera is from thirty 
'to fifty per cent, the total losses among these cases 
were barely twenty per cent, including a considerable 
number of the earliest cases, who were almost at 
death's door before the disease was properly recog- 
nized. In fact, the death-rate in the first few weeks 
of the disease was something like forty per cent, 



448 THE DOCTOR IN WAR 

showing that it was no mild or trifling type of the 
dread infection. 

Then all who had come in contact or were sus- 
pected of having come in contact with the cases, 
or had drunk of presumably infected water, were 
given the cholera vaccine, which, though not so cer- 
tain or so perfect as the smallpox and the typhoid 
vaccine, was found to give a very helpful degree of 
protection. All water-supplies for the troops and 
prisoners were, of course, chlorinated at once, so as 
to short-circuit the spread of the infection along that 
wire. 

Then the disinfection brigade got busy with their 
big tank pumps on wheels, like old-fashioned fire 
-engines, and hosed and sluiced down every infected 
building or hut or hospital with floods of perman- 
ganate and bichloride solution. In some cases they 
even went into the trenches, and flushed and flooded 
and sprayed the walls and the floor-bottoms, and the 
dug-outs and underground shelters. The germs must 
have thought it was Deluge No. 2, only a bichloride 
" Flood this time. 

Within a few weeks the new cases began to tail off 
rapidly, and although the cholera still smouldered 
along slowly, with a few scattered cases here and 
there until the approach of the cool weather sent it 
into winter quarters after its usual fashion, yet its 
back had been broken by the first rush, so that it 



MOUNTAINS AND MEDICINE 449 

was held down to a total of barely ten thousand 
cases with two thousand deaths, only a couple of 
thousand beyond the first month's outburst. 

Everybody, of course, was on the qui vive for a new 
crop of the disease in the spring, but so thoroughly 
had the work of stamping out been done, that out of 
over a million soldiers and a hundred thousand pris- 
oners on the Isonzo Front, only about twelve hun- 
dred cases developed with some two hundred deaths, 
and when I was there in August in the next cholera 
season, there had scarcely been a single case. 

But the Sanita takes no risks with its future prison- 
ers; they are made to walk the bacteriological plank 
in the most thorough-going fashion. Just as soon as 
they are brought down from the mountains into the 
first-line prison camps, which are well isolated from 
the barracks of the troops, they are first stripped 
and examined for vaccination scars against smallpox, 
and if they cannot show a clear-marked, recent scar, 
they are promptly vaccinated. As soon as they have 
recovered from this, they are given an injection of 
the anti-typhoid vaccine, then they and their cloth- 
ing are thoroughly "unloused," in steam sterilizers 
and hot baths. 

Finally, before they are allowed to go on to the per- 
manent camps or working-gangs in the interior of the 
country, the feces of every one of them are bacterio- 
logically examined for the cholera germ, to be sure 



/ 



450 THE DOCTOR IN WAR 

that there are no carriers among them. This sounds 
rather tempestuous for the poor prisoners, but as 
they are well fed, comfortably housed, kindly treated, 
and delighted to get out of the trenches, they bear 
it nobly without murmur, apparently in the philo- 
sophic hope that some future good may come out of 
all this tribulation. 

Nor are they disappointed, for the net result of 
what twenty years ago would have been viewed as 
mere doctors' fussiness and tomfoolery, is that in all 
her prison camps, in over two and a half years of 
war, Italy has scarcely had a single serious epidemic 
or outbreak of troublesome disease ! 

I visited several of these disinfection prison camps, 
and found them on well-drained ground, usually 
near the banks of some stream and surrounded with 
a high double fence of barbed wire. Along one side 
were rows of plain, comfortable, rough board bunk- 
houses, a long dining-shed and mess kitchen, in one 
of which I saw the prisoners at dinner, with appar- 
ently exactly the same food as the Italian soldiers 
were receiving in their messes. There was a good 
supply of pure drinking-water, and in front of the 
bunk-houses were one or more great cement troughs, 
almost tanks in size, forty or fifty feet long, eight feet 
wide and four deep, with a continuous flow of water 
through them from a standpipe. They had ledges 
wide enough to hold soap, towels, and small articles 



MOUNTAINS AND MEDICINE 451 

of clothing, and were used by the prisoners both for 
their own ablutions and for washing their clothing. 

On the other side of the ground was a small hospital, 
plain and rough, but clean and well equipped, with 
good bedding and blankets, and at the end near the 
entrance were the quarters of the commandant and 
of the guards. A wide strip of the ground along the 
hospital side of the camp was turned into garden, 
and planted, not merely with vegetables, but also 
with flowers, both to afford occupation for the pris- 
oners and to supply them with fresh vegetables. 

There were good latrines of the cement tank type, 
and everything was spotlessly clean, not an offensive 
odor or a sign of garbage or refuse, or a fly anywhere. 

The " unlousing " equipment is a most effective and 
interesting one. A long, shed-like, wooden building 
divided into a roomy undressing-room at one end, 
a dressing-room at the other, and between the two 
on the one side a huge steam sterilizer and on the 
other a large bathroom with hot- water douches pour- 
ing from overhead pipes. The prisoners undress in 
the first room, their clothing is put into wide-meshed 
net bags and promptly passed into the steam steril- 
izer, and they themselves march into the bathroom. 
Here they stand under the douches, and lather them- 
selves thoroughly with soap, while an orderly at one 
end of the room stands with a flexible hose, which 
he turns on their chests and backs as they rotate 



452 THE DOCTOR IN WAR 

slowly before him for inspection, to make good any 
oversights in their toilet. 

Then they go on into the dressing-room, where 
they meet their clothes which have already arrived 
from the steam sterilizer, the two are reunited and 
out they go clean and cootie-free, safe for a fort- 
night at least. The steam is superheated to such a 
temperature that all that is necessary is to open the 
bundle of clothing, give each garment a shake and 
it is dry in a second. 

The heads of the soldiers are gone over in most 
domestic fashion with the familiar fine-tooth comb 
of unblest childhood memory, and then they are 
given boxes of fragrant or rather loud-smelling salve 
containing insecticides to rub into their armpits. 

A similar equipment is a regular institution in 
every camp of a battalion or more all along the 
whole Western Front and has enormously reduced 
the Fifth Plague of Egypt. 

. Incidentally, it may be noted that this is in some- 
what striking contrast with Germany's method of 
handling outbreaks of typhus in her prison camps. 
This has the merit of being of a charming simplicity 
and inexpensiveness, and consists in promptly with- 
drawing the prison doctors and hospital attendants 
and all other German officials from the camp, post- 
ing a double guard round the barbed-wire stockade, 
throwing over supplies of food each day, and letting 



MOUNTAINS AND MEDICINE 453 

the disease run its course and burn itself out. It saves 
disinfectants and all other expense, and has in addi- 
tion the advantage, as one of the prison commandants 
explained with engaging frankness, of leaving "fewer 
of these verfliichte Englander to trouble us." 

My visit to the Italian Front was one of the most 
interesting and delightful features of my entire trip. 
It began with the inspection of some eight or nine of 
the great Base Hospitals in Rome, which were su- 
perbly equipped and managed. Two or three were 
ordinary military surgical hospitals for the wounded, 
but as Rome is a considerable distance back from 
the firing-line, the major part of its hospitals were 
utilized for medical diseases and chronic conditions 
and for reconstruction purposes, while the wounded 
were mainly sent to the great hospitals nearer 
the Front in Milan, Turin, Padua, Bologna, and 
Florence. 

One of the most interesting was an establishment 
for tuberculous soldiers in the Villa Celio, on a hill- 
top, with a superb view off over the Campagna and 
the distant hills. Here were received the men who 
had broken down, presumably from tuberculosis, 
or who had failed to pass the Draft Board for the 
same cause. They were given a thorough and careful 
X-ray examination, the Pirquet skin test for tuber- 
culosis, their sputum was examined under the micro- 
scope, and they were held under observation for 



454 THE DOCTOR IN WAR 

from one to three weeks, meanwhile sleeping on great 
galleries in the open air, liberally and abundantly 
fed, and given the best and most skilled of medical 
treatment. 

Then those who were found not to be tuberculous, 
who were quite a considerable moiety of the number, 
were sent back to their regiments or to such work 
as they were fitted for behind the lines. Those that 
were in an early stage of the disease were sent to 
sanatoria which the Italian Government had built 
since the war, up in the mountains, while those for 
whom the outlook was less hopeful, or whose disease 
was complicated by wounds or other morbid con- 
ditions, were sent to hospitals arranged for their re- 
ception, each man being sent to the establishment 
nearest to his home and family. 

The system is admirably worked out with the assist- 
ance of the Italian Red Cross. Soldiers found tuber- 
culous are given pensions for three years and support 
for their families meanwhile. The suspects among 
the repatriated prisoners of war are sent on in the 
same train to the seaside sanatorium at Nervi, which 
has accommodations for 1200. The suspects from the 
Army are sent to the sanatorium near Florence. Both 
are new and well-equipped sanatoria, beautifully 
located. The Red Cross has two trains for the tuber- 
culous, four climatic sanatoria with a total of 900 
beds, and three institutions for the moderately 



MOUNTAINS AND MEDICINE 455 

severe cases, with 640 beds. The Army has seven 
regional sanatoria, with a total of 3808 beds, eleven 
institutions for the advanced cases, besides the Nervi 
and Florence sanatoria, and centers in each army 
corps for prolonged observation and diagnosis by the 
most approved methods. Some corps have more than 
one. 

When I was at the Villa Celio, about a year and a 
half after Italy entered the war, there had been over 
thirty thousand sputum examinations made and 
about half that number of X-ray studies. And this 
is only a sample of the thoroughness and efficiency 
of the work done by the Medical Department of the 
Italian Army. At the great General Medical Hos- 
pital (Ospedale Contumaciale) at Udine, only thirty 
miles behind the Front, I was shown records of some 
fifty thousand laboratory tests and examinations 
made within the year. 

Another of the hospitals in Rome, on the Lateran 
Hill, close to the famous Sacred Staircase (Scala 
Santa), which the faithful ascend upon their knees, 
had two large wards devoted exclusively to the 
wounds of the face and jaws. Here the very best and 
most modern methods of both dental and surgical 
repair, described in an earlier chapter, were carried 
out by a competent staff, and it was a matter of pa- 
triotic pride to find that two of the most enthusias- 
tic and competent dental surgeons, who were work- 



456 THE DOCTOR IN WAR 

ing these miracles of repair and saving the poor 
wounded from a lifelong disfigurement worse than 
death, were graduates of American schools. 

At Udine I further found a complete hospital of 
two hundred beds situated in beautiful grounds and 
elaborately equipped, devoted to this same making 
of new faces for old. 

I also visited two admirable hospital schools for 
the double purpose of making and fitting the best and 
most modern type of artificial limbs for soldiers who 
had lost a leg or an arm, and at the same time teach- 
ing them, during the period that they were being 
trained to wear their new appliances, how to adapt 
themselves to their old trades, or to learn new ones 
better suited to their disabled condition. One of 
these was most beautifully and delightfully housed 
in a wing of the great Royal Palace itself, the 
Quirinal. 

The very throne-room of the Palace, which had 
been the bed-chamber of a mediaeval Pope, was 
turned into a ward and the Royal Chapel into a 
store-room for bandages and linen. 

Another beautiful villa, with acres of superb gar- 
dens and grounds, on the slope of the great Janiculan 
Hill, had been turned into a delightful hospital for 
cases of shell-shock and mental strain. If the view 
from the front piazza, including in its sweep almost 
the whole panorama of the Eternal City, as it lay 



MOUNTAINS AND MEDICINE 457 

in the sunset light on the summer evening when I 
visited it, would not start a shell-shock in the direc- 
tion of recovery, I don't know anything in the world 
that would. 

Most of the Italian hospitals were in tall, high- 
ceilinged rooms, with abundance of great windows, 
and bare, white or lightly tinted walls, such as are 
customary in hot climates and through Latin Europe 
generally. This was true both in the buildings which 
had been constructed especially for hospitals and 
those which had been simply taken over and adapted 
to the purpose for the duration of the war. Every 
imaginable type of building had been pressed into 
the service of healing in this way, convents, colleges, 
palaces, schools, villas, monasteries, and even, in 
emergency, churches and chapels, which were gladly 
yielded up for this work of mercy and of pity. A 
greater variety of architecture and of forms and sizes 
of wards could hardly be imagined, but they all 
had one feature in common, they were beautifully 
light and spotlessly clean. If by any chance they 
were n't when they were first taken over, they be- 
came so before the Sanita, or Sanitary Department 
of the Italian Army, got through with them. 

If the walls and ceilings were not absolutely im- 
maculate, they were hosed down with bichloride 
solution and then given a coat of whitewash or kal- 
somine in some delicate tint. In many of them, with 



458 THE DOCTOR IN WAR 

that natural and instinctive taste which Italians of 
all grades of social rank possess, a light band of sten- 
cil work in attractive colors was run round the walls 
or over each of the great windows, and the effect 
was extremely pleasing. Most of the floors were of 
stone or concrete, so that it was easy to keep them 
clean, and if in poor repair, to give them a fresh sur- 
face coat of cement. There were no rugs or carpets 
on the floor, except sometimes a single strip down the 
aisle, and no pictures or elaborate hangings about the 
windows to catch dust, and no corners in which dirt 
could lurk undetected, and the net result was that 
the whole group of them impressed one as among the 
most spotless and beautifully clean wards and build- 
ings which it would be possible to find anywhere. 

The kitchens and sculleries and outhouses and rear 
premises were kept equally immaculate, every scrap 
of garbage, every dustpan or shovelful of dirt, was 
sprinkled with kerosene, placed in a primitive brick 
or stone furnace, and burned. So that much to my 
surprise and delight, in the very worst month of the 
year in that scorching hot climate, August, I found 
practically no flies in the wards or kitchens and out- 
buildings, although the windows were for the most 
part unscreened. 

What was more unexpected still, this miracle of 
flylessness was achieved, not only in the great Base 
Hospitals in the cities and towns, but even in most 



MOUNTAINS AND MEDICINE 459 

of the Ospedali da Campo and Ospedaletti da Campo 
in the little villages and camps just behind the Front. 
The transport ^stables and artillery and cavalry lines 
were kept well off by themselves, and every scrap of 
manure either piled up and sprinkled with kerosene 
and burnt, or carted away by the thrifty and enter- 
prising peasantry and spread at once on the land. 

But the vigilance and passion for cleanliness of the 
Sanita did not end even here. They were thoroughly 
awake to the dangers and unhealthfulness of dust as 
well as of flies, and actually had the superb audacity 
to attack this intolerable nuisance of an army in the 
field and endeavor, as nearly as possible, to wipe it 
out, and that in a climate resembling that of our own 
Arizona or Southern California. 

And they were astonishingly successful. They at ' 
first tackled the chief and most constant source of 
dust in any climate, the roads. The world is ringing 
with the triumph of the Italian engineers in road- 
building, mountain-piercing, bridge-making, etc., and 
the superb system of beautifully built and kept 
roads, which covered the Venetian and Friulian plains, 
to serve as the main arteries of the army fighting in 
the mountains that bounded them on the north and 
east, was not the least of their achievements. They 
w/re superbly laid and graded, with a surface as hard 
/and level as a billiard table; in fact, I have never seen 
anywhere in the finest park boulevards or famous 



4 6o THE DOCTOR IN WAR 

city driveways anything finer in the form of road 
surfaces. But they were built chiefly of limestone, 
and with the incessant stream and rumble of traffic 
that poured over them, to say nothing of the tramp 
of hundreds of thousands of marching feet backward 
and forward along them day and night, would mean 
dust of a flour-like fineness and penetration, in clouds 
and clouds. 

But the ingenuity of the Italians was not baffled 
for a moment. The country is a rich alluvial deposit, 
one continuous checker-board of vineyards and 
orchards and cornfields, but thirsty in summer-time 
and has to be irrigated through ditches with water 
drawn from the mountain streams. Nothing was 
easier than to have a couple of these irrigating ditches 
running one along each side of every road; then an 
army of old men and boys is drawn up in scattered 
ranks on either side of the highway and set to work, 
first of all, sweeping all dust and dried horse manure 
and other dirt which is deposited upon the hard 
white surface of the road, shoveling it into wheel- 
barrows and wheeling it out on to the soil of the 
vineyards and cornfields on either side. 

As fast as this is done by one division, another 
division deploys into action armed with curious 
long-handled wooden scoops or hollowed shovels, 
with which they dextrously scoop up the water out 
of the irrigating ditch and send it flying across the 



MOUNTAINS AND MEDICINE 461 

clean white surface of the road. The bulk of the 
sweeping is done at night when the traffic is lighter, 
but this primitive scoop sprinkling is kept up all day 
long. Everywhere that you drive you can see the 
little jets of spray shooting up from both sides of the 
road. The system works like a charm, how perfectly 
may be gathered from the fact that during the three 
August weeks which I spent in motoring up and down 
the Front and backward and forward along these 
roads from Headquarters and the Bases, I never 
once found it necessary to wear a dustcoat, let alone 
goggles or a veil, and only upon one or two occasions 
was there enough dust in the air to attract attention. 
The difference which this triumph over road dust 
made to both the comfort and the health of the march- 
ing columns, to say nothing of the poor horses and 
mules, can easily be imagined but hardly overesti- 
mated. It was actually found to diminish markedly 
the amount of catarrh and other irritations of the 
nose, throat, and eyes of the soldiers, and to keep 
their feet in very much better condition, less likely 
to chafe and blister on the march, while if chafes or 
blisters did form, they healed more rapidly and 
kindly than when exposed to the often infected and 
poisonous dust of the ordinary roads. It is only fair 
to add that there was another purpose also for this 
painstaking campaign against dust, and that was 
that the majority of these roads were not only in 



462 THE DOCTOR IN WAR , 

plain view of the Austrian observation posts up in 
the mountains, which overlooked them, but exposed 
to shell-fire from the Austrian guns. Hence it was of 
the greatest importance that the Austrian observers 
should not be able to detect readily extensive troop 
movements by the columns of dust sent up, and also 
that the roads themselves should not advertise too 
constantly and obtrusively their own position, so as 
to give their range to enemy gunners. So that the 
Sanita had the weighty and influential backing of 
the General Staff and of the line in their brilliant 
attack upon the dust nuisance. But such was the 
addition to the marching power and comfort of the 
troops and the cleanliness and freedom from dust and 
grit of the guns and other elaborate machinery of 
war transported over these roads, that the line officers 
frankly admitted that the work was well worth all 
it cost, even apart from its value in concealing the 
movements of troops or of supply-trains from the 
enemy. 

Similar precautions of constant sprinkling, com- 
bined with the burning or burying of all sweepings 
and camp waste, were carried out in most of the 
camps in the plains, to the great advantage and com- 
fort both of the troops and of the wounded in the 
hospitals about. 

The same precautions were taken with the batter- 
ies and gun emplacements, and I was considerably 



MOUNTAINS AND MEDICINE 463 

amused, on visiting some of the English heavy 
artillery posts on the edges of the Corso, to hear the 
men grumbling about the fag and nuisance of per- 
petually hauling water in carts and casks from a 
river or pool a couple of miles away, in order to keep 
the ground around the belching monsters well wet 
down, so that the tremendous shock of their recoil 
would not send the telltale cloud up into the air to 
furnish a clue to the Austrian batteries above them. 
One somehow had never thought of a water cart as 
part of the necessary equipment of a nine-inch gun. 

A more ideally beautiful theater of war could 
hardly be imagined than the broad green Venetian 
plain, bounded on the left by the crescentic rampart 
of the Julian Alps sweeping down to Trieste and the 
Gulf in front, and by the violet blue waters of the 
Adriatic on the right. The plain was intersected 
every three or four miles by the shallow valleys of 
swift, sparkling, mountain streams, which in the 
summer-time sank into the earth before they reached 
the sea, like the rivers of Southern California, and 
dotted all over with scores of little gray-walled vil- 
lages and venerable towns, each with its tall white 
church-tower, half spire, half watch-tower against 
Moorish and Turkish pirates. Every one of these 
little villages was swarming with troops and ringed 
about with camps. And every one had furnished 
from two to five or six high-vaulted, white-walled 



464 THE DOCTOR IN WAR 

rooms for use as hospitals. The result was some most 
picturesque and striking contrasts. In one village I 
saw wounded Arditi and bandaged Bersaglieri lying 
in cots with their heads just under the gilded frame 
of a magnificent painting valued at twenty thousand 
dollars, with the rest of the equipment on the walls 
to match. This was in the villa of one of the Italian 
nobility, and it had other advantages as a hospital 
besides its beautiful pictures and magnificent furni- 
ture. The wife of the nobleman happened to be an 
Austrian princess and as a consequence, although all 
the villages and camps round about were scourged 
time and again by the Austrian fire, not a single shell 
ever fell upon this villa or in the little village clus- 
tered round the foot of the hill on which it stood. 
German and Austrian gunners may not intentionally 
shell hospitals, but they certainly can intentionally 
miss them when they want to. 

Another romantic illustration of their powers of 
sparing certain buildings and regions was furnished 
on this same Italian Front, not twenty miles away 
from this hospital villa. Right on the crest of one 
of the highest ridges, which the Italian troops had 
wrested from the Austrians after furious fighting, and 
looking directly down upon the valley of the Isonzo 
where the armies were locked in mortal combat all 
summer long, was a little memorial chapel known as 
Santa Maria Zan. Every village and every church, 



MOUNTAINS AND MEDICINE '465 

within five miles of it on either side and behind, had 
been battered into a mass of ruins; but its slender 
tower still rose toward the sky untouched, with not 
even a slate missing from its roof. The reason given 
for its singular immunity was that one of the favor- 
ite mistresses of the earlier and happier days of the 
Emperor Franz Josef was buried there. And as her 
tomb was plain to be seen just to the side of the 
altar and no other conceivable reason could be im- 
agined for its escape, the explanation was at least 
highly probable. 

I found another group of wounded soldiers lying 
in comfortable white cots in the dim religious light 
of stained-glass windows in a beautiful old church, 
or rather chapel of a monastery. At the other end of 
the scale, one of the busiest war hospitals which I 
visited was in an abandoned railway tunnel, drilled 
through the wall of the cliff-sided gorge of the Isonzo, 
another was in the entrance to an abandoned mine 
in the side of Monte Vodice, but in all of them alike, 
the wounded had had the best of attention and were 
resting as comfortably as their wounds would permit. 

Two of the most picturesque hospitals that I 
saw on the Isonzo Front were in great, roomy, old- 
fashioned barns and granaries, with the huge roof 
beams and the under side of the tiles for their only 
ceiling. But these again had been thoroughly house- 
cleaned and whitewashed from floor to roof -peak by 



466 THE DOCTOR IN WAR 

the Sanita, and in one of them the wounded thought 
they were in clover and gave themselves great airs 
of superiority, because they were in the hands of 
the English Red Cross and waited upon by trained 
women nurses. 

The most striking one of the whole series was the 
great riding-school of a big cavalry barracks, which 
had been converted into a single oval ward over six 
hundred feet long and with eleven hundred cots ar- 
ranged in orderly rows upon its floor. As it was over 
sixty feet high in the center, its spotless white arching 
roof and delicately tinted walls, with its brilliant 
light, made it look like a literal temple of light and 
healing, though it must have been a fearful business 
to try and keep it warm in winter-time. 

One new and interesting feature which the charac- 
ter of the country fought over has brought about is 
the great variety of means for the transportation of 
the wounded. First and far most frequent of all come 
the great motor ambulances, many of them of their 
own splendid Italian makes — Fiats, Lancias, and 
the like. Everywhere that the superb, boulevard- 
wide, billiard-table-level, military roads of the Ital- 
ian engineers go — and they go pretty nearly every- 
where — these rubber-tired, one-car hospital trains 
de luxe roll up to the Dressing-Stations and roll down 
again with the wounded in comfort and safety and 
speed. Just as an illustration of what their engineers 



MOUNTAINS AND MEDICINE "467 

can do, I rode in a big Army limousine over a splen- 
did road, with a surface like a floor, climbing in great 
sweeps and spirals right up to within a few hundred 
yards of the front-line trenches along the crest of 
Monte Vodice, over three thousand feet above the 
waters of the Isonzo, within three weeks of the day 
that it had been captured from the Austrians! 

The only drawback to travel on these magnificent 
roads is that their inner side is a perpendicular wall 
of rock, their outer a sheer drop of hundreds of feet 
into the valley below, and your motor, being the 
lighter and more mobile vehicle, has to take the 
outer edge and give the wall to the ammunition 
wagons and motor " camions.' ' And there is no 
parapet, not even a hand-rail, if — ! 

But then, as one of Mr. Shaw's topsy-turvy Cock- 
ney heroes remarks: "Hif you wunst begins to think 
— then good-bye 'appiness!" So you don't, but just 
sweep blissfully onward through the gap between the 
drop and the dynamite. 

Next after the lordly Fiats come the old-fashioned 
- wooden- wheeled, horse- or mule-drawn ambulances 
which, though with jolts and joggles incarnate, can 
scramble up steep-sided gullies or over rocky ledges 
and boulder-strewn mountain fords, where the rubber 
shoe of the motor could scarce dare a foothold. Ex- 
cept for short distances in rough and difficult country 
they are now chiefly used for the transportation of 



468 THE DOCTOR IN WAR 

the walking wounded, carry-all fashion, or for dis- 
tributing the less seriously injured from the great 
Collecting-Stations a mile or so behind the Front to 
the near-by field and village hospitals, where the 
roads are comparatively level. I visited one of these 
Collecting-Stations about five o'clock in the after- 
noon, which had handled fourteen hundred wounded 
since daybreak that morning, and they were still 
pouring in. i 

Then come curious country carts drawn by sure- 
footed little mountain ponies or donkeys, curious to 
look upon and jolty to ride in, but capable of twist- 
ing their devious way up or down almost any moun- 
tain-side. And for the still more difficult places were 
litters, or long-shafted stretchers slung between two 
furry-eared donkeys or a couple of shaggy ponies; 
and last of all, of course, the old reliable and abso- 
lutely indispensable hand-stretcher, carried between 
two bearers, or in difficult places lifted high on the 
shoulders of four. 

But the most unique and effective means of bring- 
ing down the wounded in high mountain fighting was- 
the miniature cable-railway, or "telef erica," one of 
which was in full swing just behind the busy Collect- 
ing-Station bringing down the wounded from the 
tops of Monte Kuk'a mile and a half away across 
Ahe valley. 

These wonderful little air-line trolleys, whose glit- 




TRANSPORTATION OF WOUNDED BY TROLLEY IN THE 
ITALIAN MOUNTAINS 



t 



MOUNTAINS AND MEDICINE 469 

tering cables of woven and twisted steel festoon all 
the mountain chains of the Italian Front, like a giant 
spider's web, loop peak to peak, and mountain-side to 
mountain-side across the gulf between, like the flight 
of a bird, or leap from the bare brink of the precipice 
down to the green valley below in one swoop and up 
to the glaciers above in another. 

They did not originate in this war, any more than 
most of the other agencies which it employs, but have 
been in use for years in mining operations in moun- 
tainous regions, particularly in the South American 
Andes. And as the Italians are extensively interested 
in many enterprises in South America, particularly 
in the Argentine, their engineers brought back with 
them the idea of the overhead cable trolley and pro- 
ceeded to adapt it for military purposes. It has 
proved so extraordinarily useful, in such an infinite 
variety of ways, that it would be really difficult to 
conceive what this war would be like in the high 
mountains without it. It plays as important a part 
among the peaks and mountain valleys as the motor 
does in the plains below. 

In principle and construction it is simplicity itself, 
just a double line of swaying steel cable from half a 
mile to a mile and a half long stretched up the side 
of' a mountain, across a valley, or in relays down 
the whole length of it, with little basket-cars slung 
on it on a deep-grooved trolley wheel and drawn 



470 THE DOCTOR IN WAR 

by a smaller and lighter cable wound over a rolling 
drum. 

The passengers, food, ammunition, or supplies are 
placed in the little basket-car of perforated sheet steel 
and sent sailing and swaying swiftly and merrily up 
or down the face of a precipice, or across a mountain 
gorge with the roaring torrent brawling Heaven 
knows how many hair-raising thousands of feet be- 
low, until with a jerk and a click you arrive along- 
side of a narrow platform like the one you started 
from, climb out of your basket, walk across the plat- 
form, scramble into another basket, and off you go 
with a heave and a swoop on the next stage of your 
journey. 

Where the cables can be securely braced, or sup- 
ports can be slipped in at intervals, these flying bird- 
cages, these spider-trolleys can sail a mile or even a 
, mile and a half at a stretch, but ordinarily they are 

y laid out in flights of about half to three quarters of 

a mile, with a platform and station-house sheltering 
the gasoline engine, which drives the drum and sup- 
plies the motor power, at the end of each section. 

As each section or unit of the line costs roughly 
about ten thousand dollars including price of gaso- 
line-engine, cables, cars, and installation, though 
this last, of course, varies considerably with the lo- 
cation, and as each car will carry six hundred pounds 
and can be run at about two minutes' intervals 



MOUNTAINS AND MEDICINE 471 

(headway), they are not an expensive form of trans- 
portation. Indeed, in that sort of country and by 
comparison with the cost of carrying by pack-mules 
and trails, they are remarkably cheap. And where 
time is a consideration they are literally "out of 
sight" of the pack-trains. For instance, the series 
of five mortal risks by which I sailed from the valley 
up to the glacier, eleven thousand feet, on Monte 
Adamello, in the Trentino, landed me gasping on the 
eternal snow in a little less than an hour and a quar- 
ter, while the same climb on mule-back would have 
taken eight and a half, and with pack-mules four- 
teen hours. 

The flying tea-tray could make almost twelve trips 
while the pack-mules were making one. But it's a 
gulpy and giddy sort of "proposition" at first. You 
walk into the little shed station, where your big mili- 
tary motor has dropped you after a nerve-testing 
climb up extraordinary zigzags and around extremely \ 

unprotected corners, with as brave and nonchalant 
an air as possible, and cast a glance at the shiny 
twin cables that go sweeping up to your first landings 
perch on a shelf twelve hundred feet above you. -; 

So far, so good. They look as if they might hold 
you up — if nothing went wrong. Then you turn 
around and look for your car, expecting to see some- 
thing resembling a small elevator-cage, or at least a 
deep-seated basket into which you could snuggle 



472 THE DOCTOR IN WAR 

down and fasten the cover over the top of you. But 
you see nothing of the sort, and finally you ask where 
it is and your officer-guide, politely struggling to hide 
a smile, points it out to you right under your very- 
feet. And there, lying close alongside of the little 
twelve by six platform, is a ghastly little tea-tray of a 
thing about the shape and solidity of one of these 
little wire-mesh baskets that run along the ceiling 
and bring you back your parcels and change in a de- 
partment store — only smaller! 

As a matter of fact, it is about six feet long, three 
feet wide, by six inches deep, though it looks to your 
horror-stricken eyes of about the dimensions of a pen- 
tray, or one of these baskets on a desk in which "in- 
coming" or " answered" letters are kept. 

The bottom is solid, thank God, but the blither- 
ing six-inch sides are all perforated open-work, which 
makes them look about as solid and protective as a 
strip of mosquito-netting. But it was the ends that 
gave you palpitation of the heart. They were on 
hinges and were laid back wide open, as the car 
had just been carrying lumber. 

When I could get my breath, I jerked out: "For 
Heaven's sake, shut those end-gates!" And we were 
to swoop up the mountain-side in that magnified 
pie-pan, without even a crust over us, and nothing 
whatever above us or on either side in the way of sup- 
port or protection but that single spider-web cable 



MOUNTAINS AND MEDICINE 473 

against the blue, blue sky and the iron fork which 
hung us from our trolley-wheel above. 

I don't mind confessing that I played " Safety 
First " and lay flat on my back on that flying cot try- 
ing to dig my shoulder blades into the floor under- 
neath, and gazing hopefully up into the blue sky to 
try and forget the six hundred feet of empty space 
which came between me and the rocks and trees 
below. 

But on the second stage I ventured to lift my head 
and cautiously peek over the six-inch rail into the 
depths beneath. On the third I sat up and began to 
admire the scenery, and by the fourth I had to be 
cautioned not to hold my head so high when I was 
going under the "low bridge" arch of an extra sup- 
port. After that I was ready to skate off anywhere 
on a "telef erica?*- and was only inclined to regret 
that they could n't be used on the level in the dull 
world below. 

Really the motion is distinctly pleasant, and the 
sensation of sweeping free through the air quite ex- 
hilarating, after you once get over the first feeling of 
awkwardness and can forget to think about what 
might happen if the cable broke or an enemjf shell hit 
it or your trolley ran off or the hauling line snapped. 
Also my guide informed me that in the event of a 
sudden squall of wind, quite common among those 
mountains, the cable would get to swaying so vio- 



474 THE DOCTOR IN WAR 

lently that it was n't safe for the engine to wind up any 
further on the line for fear of breakages, and you just 
had to stay out there and swing back and forth, pen- 
dulum fashion, until you gradually "cat-died" to rest 
again and could be hauled on up to the top. The sec- 
ond party before us had been caught in just such a 
squall and had done the "Rock-a- bye-baby" act for 
nearly an hour and a half before it was safe to haul 
them on again. 

Another thing which caught my anxious and in- 
quiring eye was the utter absence of anything in the 
slightest degree resembling a brake on the machine. 
I asked my officer-guide and he replied, with a reas- 
suring smile, "Oh, it is unnecessary, quite unneces- 
sary, Signore." "Oh, I see, we could grab the cable 
with our hands and hold ourselves, couldn't we?" 
"Have no fear, Signore, have no fear," he smiled 
again, "if the drum line should ever break, nothing 
under the blue heaven could stop us until we arrived 
at the platform below, and of that, of course, we 
should know nothing. So why worry about such a 
trifle as the absence of a brake ? " 

But one soon learns to forget such considerations 
as these and to console one's self with the comfort- 
ing practical thought that as a matter of fact the 
lines are so well built and the cables so carefully 
woven and tested that there have been surprisingly 
few fatal or serious accidents on these "telef erica" 



MOUNTAINS AND MEDICINE 475 

lines. Though I never got to feel quite comfortable 
coasting with both end-gates down, especially the 
lower one, which I once discovered just as we had 
swooped about a hundred feet below the perch. 

But they are God's mercy to the poor wounded, 
who fall on the glaciers or on the high mountain- 
slopes. In fact no other method of transportation 
whatever can compare with these flying cots in 
smoothness, swiftness, and utter absence of jolt or 
jar or unpleasant movement of any description. 

They had done yeoman service only about six 
weeks before my visit, bringing down over six hun- 
dred from the battle of Corne Caventi, fought in 
trenches cut in the solid glacier ice, nearly thirteen 
thousand feet above the sea. 

But this battle above the clouds was fought some 
three miles beyond the highest Alpine garrison post 
and seven miles of crevasse-seamed glacier surface 
lay between its trenches and the topmost platform of 
the last "telef erica." How were the wounded to be 
transported across this gap? By the last and most 
picturesque of ambulances on this romantic front, 
Eskimo-dog sledges, each drawn by two big woolly 
"huskies," or, as the Alaskans say, "malamoots." 

A rough sledge-track was broken out and trampled 
down across the humpy and rolling surface of the 
glacier, which looked much as if a rather dirty ocean, 
with a choppy sea on, had suddenly been frozen 



476 THE DOCTOR IN WAR 

stiff. Though it wound in and out to avoid the 
worst of the bottomless cracks, which criss-crossed 
the glacier in every direction and surged up and 
down over the long swells of the frozen sea, the 
sledges would ride over it without many serious or 
troublesome jolts or jerks, so that the wounded, 
well bandaged and wrapped up, made the crossing 
in comparative comfort and were safely delivered at 
the topmost platform of the "telef erica.' ' 

From this they were lifted without change or dis- 
turbance, still in their stretchers, right into the steel 
basket, and were shot gently and swiftly downward 
with only one "change of cars," and even then the 
Pullman berths went right through, to the Refugio 
Garibaldi, the highest, if not the greatest, hospital in 
the world, perched on a little valley shelf among the 
peaks and above a precipice nine thousand feet in 
air. Here they were carefully looked over by the 
surgeons to see that everything was all right and 
ship-shape about the dressings, and those who were 
in serious or critical condition from wounds in the 
head, abdomen, etc., were taken directly to the Hos- 
pital, operated upon, and kept in comfortable wards 
until they were able to travel on down to the valley. 

There were only about twenty of these bandaged 
heroes left in the Hospital at the time of my visit, and 
they were all convalescent, the others having recov- 
ered and been sent on down the mountain. They 



MOUNTAINS AND MEDICINE : 477 

looked very comfortable and happy sitting and loung- 
ing on the green slope between the Hospital and a 
tiny lake in the saucer of the wee valley, and were 
formally presented to me by the young surgeon in 
charge as "the blesseds of the Adamello," which 
they certainly were and looked. 

For the more lightly wounded it is only three more 
swoops and a four-mile roll in a big motor ambulance 
over perfect roads down to the Field Hospitals in the 
villages of the upper valley or a ten-mile one to the 
big Base Hospitals in the bustling town among the 
meadows in the main valley below. 

These dog-teams and sledges were in constant use 
up on the glacier as the chief means of transportation 
for all sorts of supplies from the main post at the top 
of the "telef erica" to the advanced garrison outpost 
three miles away across the glacier: partly on account 
of the difficulty and expense of hauling up the bulky 
fodder and grain, which would have been needed for 
mules or ponies, but more on account of the narrow 
and constantly shifting trails across the dangerous 
crevasses of the glacier. The whole surface of the 
glacier was seamed on an average about every hun- 
dred yards with these perilous fissures, most of them 
fortunately only six inches to a couple of feet in 
width, but if you looked down into them as your 
sledge was being dragged across them, you gazed 
into steely blue depths that made you shiver. 



478 THE DOCTOR IN WAR 

As my officer-guide* facetiously remarked, just 
after crossing one of them, which was fully half as 
wide as my sled-runners were long: "If you wish to 
become immortal, Signor Dottore, all you have to 
do is to plunge in there. You will be beautifully pre- 
served in cold storage for perhaps two hundred years 
and then reappear to the admiring public eye, as nat- 
ural as life, at the foot of the glacier below." I said 
I would think about it later when all other hopes 
of leaving anything to be remembered by had failed. 

But these children of the high Alps don't let little 
things like that worry them in the least; as long as 
the crevasses across the trail are not more than eight- 
een inches wide, so as to be bridged by the runners of 
the dog-sledges with a foot to spare at each end, they 
pay no attention to them, but just ride straight 
across. 

When they open to a width of two feet or more, 
they take two or three planks or the top of a packing- 
case, lay it across the crevasse, shovel a little snow on 
it to make it good sledding, and then the traffic goes 
merrily on over. If the crack gets to be two yards 
or more wide, then they will go the length of a little 
wooden bridge of inch boards with a hand-rail on one 
side. Over the rail of one such massive structure we 
could actually look down into a huge, violet, cathe- 
dral-shaped ice cavern, as big as the Grand Central 
Station, along the peak of whose roof ran our ere- 



MOUNTAINS AND MEDICINE ; 479 

vasse and hear the brawling of the glacier stream 
eight hundred feet below. 

The only animals that can be got to walk across 
structures like that are dogs and men — mules have 
too much sense. Nor was the danger of the roof of 
the Grand Central Station yawning and swallowing 
you up purely imaginary. At the main garrison-post 
they showed us great caverns which had opened in 
the ice, beginning as mere two-inch cracks, right in 
under the side of one of the barracks and the end of 
another, so that they had to be perpetually on the 
lookout and ready to move to another and as yet 
safer site. The gulf that had opened under the end 
of an abandoned cook-house was already thirty feet 
across and of a depth that ended in a floor of blue 
haze. 

This was the reason why they used those curious 
shack-like hut shelters up in that region of intense 
cold, because they would straddle lightly over the 
surface and were too long to fall into any crevasse 
which was likely to open suddenly, and also could 
be quickly pulled down and moved to safer ground, 
or even snaked along the surface of the ice. 

The dogs had a special big barrack of their own, 
just as tight and comfortable as those of the soldiers. 
There were between fifty and sixty of them — great, 
big, handsome fellows — with thick, wavy or shaggy 
coats and long, wolf-like tails, looking like a cross 



480 THE DOCTOR IN WAR 

between a rough-coated St. Bernard and a big hairy 
collie. As a lifelong dog-lover and breeder, I in- 
quired at once as to their blood, but was told 
that they were of no particular breed, just the dogs 
used by the shepherds and herdsmen in the High 
Tyrol. 

Possibly they were also related to the famous dogs 
of the St. Bernard Pass, who, however, were probably 
developed from a similar if not a common stock. In 
fact the head-keeper, when asked if they weren't 
part St. Bernard, replied with a shrug of the shoul- 
ders, "Ah, yes, perhaps; but perhaps the St. Ber- 
nards are half them! " — clearly of the opinion that 
there were other famous dogs in the world besides 
those of the great monastery. 

I was greatly amused to find that these devoted 
and much-petted dogs were not only treated, but also 
fed, like human beings. They were given macaroni 
and soup and rice, with great ladlefuls of beans, fla- 
vored with cheese or dried fish. All these were dished 
out hot and smoking, one after another, into great 
soup platters, such as the soldiers use, laid the whole 
length of their comfortable kennel hut, between two 
eagerly waiting lines of hungry dogs. They sat up at 
strict attention, without a sound, though with slob- 
bering lips, until the last ladleful had been dished out. 
Then at a sharp word of command from the chief 
driver they sprang forward, like a shot, and cleaned 



MOUNTAINS AND MEDICINE 481 

up every platterf ul to the last drop with gleeful gob- 
blings. 

The Alpini Commandant assured me that they 
could not keep their strength and endurance on any 
less choice and nourishing food ; indeed, the expense 
of transportation up to that high altitude, twelve 
thousand feet above sea level, was so great that it was 
not worth while bringing up any except the best and 
most concentrated foods. To crown all, he informed 
me that the head driver, who loved them like children, 
insisted that the dogs actually needed a small "shot" 
of hot coffee, with condensed milk and sugar in it, 
every morning just to warm up their stomachs against 
the bitter mountain cold, for the day's work; just as 
the soldier thinks the world of his thimbleful of hot 
rum in the early dawn in the trenches, especially 
before he goes over the top. Dogs are very much like 
men and both extremely human, after all. 



THE END 



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